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Office of Sexual Misconduct Reporting & Response Incident Report Form


Sexual or Gender-Based Discrimination, Harassment, Misconduct, and other Discriminatory Harassment



Please note that submissions using this form may not be reviewed outside of normal business hours. If you believe you or anyone else is in immediate risk to health or safety, call 911 or the University Police at 814-863-1111.

As members of the University community, faculty and staff have a responsibility to report behaviors that potentially constitute sexual or gender-based discrimination, harassment, misconduct, or other discriminatory harassment. In addition, we encourage any person who becomes aware of such behaviors to utilize this form to notify the University.

Individuals should submit this form when they become aware, directly or indirectly, of an incident in which the victim or the offender is a Penn State student, faculty, or staff. Information provide may be from personal observation, a verbal or written report from a victim, or a verbal or written report through a third party who either observed or became aware of the incident.

Even if one is unsure if a specific behavior constitutes a violation, or even whether or not the alleged offender is a University student, faculty, or staff, they are encouraged to complete the form and provide the information anyway.

Once the form is submitted, it will be sent to the Office of Sexual Misconduct Reporting & Response and the Office of Equal Opportunity and Access for review and appropriate response.

Background Information

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(e.g., student, faculty, community member, Associate Dean, Director)
Email address must be of a valid format.
This field is required.
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Select incident type. Visit reporting.psu.edu for other reporting options.
This field is required.
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If unknown, type 01-01-1900
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If unknown, type unknown
This field is required.
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Location where incident occurred. This may not be the same as where you learned about the incident.
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(e.g., address, building, residence hall room #, fraternity)

Involved Parties

Please list all of the individuals involved including as many of the listed fields as you can provide. For non-students, you may use a Drivers License number in the Student ID Number block, if available.

Involved party 1

Incident Information

For additional information regarding University policies, guidelines, and definitions please see our website.

Please check all behaviors alleged to have occurred:(Required)
You must make at least one selection.
This field is required.
This field is required.
Has a Campus Security Authority (CSA) report form been submitted? If yes, please attach email confirmation of report submission. (Please verify the CSA form has saved properly, with all fields saved before it is uploaded.) https://www.absecom.psu.edu/CAMPUS_SECURITY/security-incident-form.cfm
This field is required.
Has a Childline report form been submitted? If yes, please attach email confirmation of report submission. (Please verify the Childline form has saved properly with all fields saved before it is uploaded.) Refer to https://policy.psu.edu/policies/ad72 for the University's policy on reporting suspected child abuse.
This field is required.

Supporting Documentation

Please attach email confirmation of CSA report submission, if applicable, along with any documentation supporting this report. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission