This form is intended to convey information needed to track the University’s response to the incident being reported, as well as to assess the danger the incident represents to the University community at large. All efforts must be made to maintain the victim’s anonymity; no information should be included which might identify the victim. The victim may refuse to answer any or all items on this form: However, the report that a sexual offense occurred must be made. This form is to be forwarded to Associate Vice President of Student Affairs/Dean of Students, Picciola.
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