Report An Incident

Report an Incident

This form is used to report incidents of sexual violence and sex- and gender-based harassment prohibited by UT Southwestern's Sexual Discrimination Policy. Sharing this information allows us to respond in an effort to stop such misconduct, eliminate any hostile environment, take reasonable steps to prevent a recurrence of such misconduct, and address any effect that such misconduct may have on the larger University community.

Reporter information

Your first name*Required × Error: A field is missing data or special characters were used. Please correct.

Your last name*Required × Error: A field is missing data or special characters were used. Please correct.

Your phone number (123-456-7890) × Error: A field is missing data or special characters were used. Please correct.

Your email address (you@someplace.com)*Required × Error: A field is missing data or special characters were used. Please correct.

Your university status

× Error: A field is missing data or special characters were used. Please correct.

Date incident reported to you*Required × Error: A field is missing data or special characters were used. Please correct.

Involved persons

Please share as much information as you know about the individuals involved (excluding yourself).

× Error: A field is missing data or special characters were used. Please correct.

Description/Narrative

Use the following prompts to share your knowledge of the incident. The fields are open-ended text fields to allow for descriptions such as "two days before Spring Break 2014," "the sun was already up," or "near the lake" instead of an exact date, time, or location. It is OK if you do not know or do not remember all details; share as much as you know or can remember.

Date(s) of incident(s) × Error: A field is missing data or special characters were used. Please correct.

Time(s) of incident(s) × Error: A field is missing data or special characters were used. Please correct.

General location of incident

× Error: A field is missing data or special characters were used. Please correct.

Specific location of incident × Error: A field is missing data or special characters were used. Please correct.

Please share as much detail as you can about the incident*Required × Error: A field is missing data or special characters were used. Please correct.

One last step ...

Email me a copy of this report
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× Error: A field is missing data or special characters were used. Please correct.

*Required