Anonymous Report of Sexual Assault - Florida Southern College in Lakeland, FL

*Nature of assault (check all that apply)

Sexual Discrimination Sexual Harassment Retaliation Sexual Violence Dating Violence Domestic Violence Stalking Other

*Location assault occurred

Residence Hall On-campus Apartment Community On-campus Non-Residential In the Classroom Off-Campus Don't Know

*Please provide details of the incident

*Date/Time of Incident

*Status of the person experiencing the sexual discrimination

Student Staff/Administrator Faculty Non-Student Unknown

If student, select from list

First-Year Second-Year Third-Year Fourth-Year Graduate Student Unknown

*Gender of survivor/complainant

Female Male Trans Identifying Gender Queer - Gender Non-Conforming Different Identity Prefer Not to Answer

*Gender of accused perpetrator/respondent

Female Male Trans Identifying Gender Queer - Gender Non-Conforming Different Identity Prefer Not to Answer

*Respondent First Name

*Respondent Last Name

If you are not the survivor, how did you learn of this incident?

Survivor Witness Told by the survivor/complainant Told by the accused perpetrator/respondent Told by another party Other

I would like to identify myself or receive help from the Office of Accountability, Education and Compliance

Would you like someone from any of these offices to follow up with you?

Student Counseling Center Campus Ministries Campus Safety and Security Student Health Center Academic Center for Excellence

Is anyone else aware of the incident?