Sexual Violence Anonymous Reporting Form

This form should be used by members of the Youngstown State University community who have experienced or have been witness to sexual violence (sexual assault, rape or sexual battery). The information will be used to identify and address troubling trends.

If a perpetrator is named, the Title IX Coordinator, or his/her designee, will meet with that person to share that the person was named in an anonymous report, review the Sexual Misconduct Policy, and inform the person that if the allegations are true, the behavior needs to cease immediately. Information shared in this form alone will not result in anyone going through the student conduct or employee discipline process. In compliance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act) (20 U.S.C. section 1092), information submitted via this form reflecting a reportable crime, as defined by the Clery Act, will be included in the Campus Safety Daily Crime Log. No names are included in the Daily Crime Log.

Date of Assault (Leave blank if unknown)
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