Sexual Misconduct Incident Report

This form is for reporting sexual misconduct incidents to Radford University Substance Abuse and Violence Education Support services (SAVES) to assist with providing resources and support to sexual violence survivors/victims. Completing this form will not result in an investigation but may be used to convey reportable Clery Act statistics to Radford University Police; information contained on this form will remain confidential and will only be used in non-identifying ways.

The person completing this form can remain anonymous or provide contact information that will only be used if the person completing this form requests to be contacted by a SAVES staff member. Someone other than the survivor/victim may make reports.

Submitted online reports may not be immediately viewed by SAVES. If you are in danger or in need of immediate medical attention, please call 911. If your situation is not an emergency but you would like to speak with someone quickly, please contact SAVES at 540-831-5709 during business hours of 8:00am-5:00pm, Monday-Friday. If you would like to speak to an advocate outside of SAVES business hours, please contact the Women’s Resource Center of the New River Valley at 540-639-1123.

No section of this form is required. It is okay if you do not remember something or are unsure of what exactly happened. Please complete the form to the best of your ability while keeping in mind there is no pressure to provide information or guess if you are unsure of how to respond to a section on the form.

Tell us what you are able to about the incident. If possible, please include a classification of the type of incident, such as sexual assault, dating or domestic violence, stalking, or harassment.

Please tell us what you are able to about the location of the incident, such as an address, on-campus, off-campus, private residence, public location, etc.

Please tell us what you are able to about the assailant. If name is unknown or you do not wish to disclose name, you can include information such as number of assailants, gender, and physical description. If applicable, you may also provide information on any current or previous relationship with the assailant. This section can be left blank if you are unsure of information about the assailant.

Is there any other information you want us to know?

 

You are not required to provide contact information but we would appreciate the chance to speak with you further. If requested, we will contact you as soon as possible during SAVES business hours.

 
 I am including my contact information above and would like to be contacted by a confidential SAVES staff member by phone.
 I am including my contact information above and would like to be contacted by a confidential SAVES staff member by email.
 I am not the survivor/victim in the situation reported above but would like to be contacted by a confidential SAVES staff member by phone.
 I am not the survivor/victim in the situation reported above but would like to be contacted by a confidential SAVES staff member by email.
 I am including my contact information but do not wish to be contacted at this time.
 I am not including my contact information.
 
 
 
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