Sexual Misconduct and Title IX Third-Party Report

Please complete the requested information to the best of your abilities. 

(*) indicates a required field

Important Notes:
  • If you choose to report anonymously, please understand that the college is limited in being able to reach out to the individuals who have been harmed and/or taking steps to remediate the situation.
  • Please reach out to Campus safety for additional assistance at 920-403-3299 or campusafety@snc.edu.
  • To talk with someone confidentially, student confidential resources and faculty/staff confidential resources are available.
Third Party Information
*Name:
You can write in "anonymous" if you do not wish to disclose your name. However, if you are a mandatory reporter, you must identify yourself. (also see 'Important Notes' above)
Phone number:
Email address:
*Please select which best fits your primary status:  St. Norbert College Undergraduate Student
St. Norbert College Graduate Student
St. Norbert College Faculty
St. Norbert College Staff
Other, please specify:
Alleged Survivor's Information
Alleged survivor refers to the individual who has been hurt or targeted by the sexual misconduct or Title IX violation or incident.
*Alleged survivor's name (if known):
You can write in "anonymous" if you do not know the name of the alleged survivor.
Alleged survivor's phone number:
Gender of the alleged survivor:  Male
 Female
 Transgender
 Another identify, please specify: 
*Please select which best fits the alleged survivor's primary status:  St. Norbert College Undergraduate Student
St. Norbert College Graduate Student
St. Norbert College Faculty
St. Norbert College Staff
Other, please specify:
Responsible Individual's Information
Responsible individual refers to the individual responsible for the sexual misconduct or Title IX violation/incident otherwise known as the alleged perpetrator.
*Responsible individual's name (if known):
You can write in "anonymous" if you do not know the name responsible individual.
Responsible individual's phone number:
Gender of the alleged responsible individual:  Male
 Female
 Transgender
 Another identify, please specify: 
*Please select which best fits the alleged responsible individual's status:  St. Norbert College Undergraduate Student
St. Norbert College Graduate Student
St. Norbert College Faculty
St. Norbert College Staff
Other, please specify:
Report Information
*Hover over terms below for a definition.
*Type of alleged sexual misconduct or Title IX concern: Sexual Harassment
 Sexual Assault
 Sexual Violence
 Stalking
 Dating/Domestic Violence
 Gender-Based Misconduct
 Unknown
Other, please specify:
*Description of violation/incident:

Describe your knowledge of the sexual misconduct or Title IX violation/incident to the best of your ability.
*Location of the alleged sexual misconduct or Title IX concern: On campus (please specify):
Off campus (please specify):
 Online
 Unknown
*Upon receipt of this report, what do you want to happen?:  I would like to be contacted. Please note that you will need to provide your name and contact information above for us to contact you.
 I do not want to be contacted. I would like the report to be utilized by the college solely for informational purposes.
*Declaration
 I understand that St. Norbert College takes all possible sexual misconduct or Title IX violations/incidents very seriously. By submitting this form (which is received by the Title IX Coordinator), I am indicating that I understand and agree that the information I have provided may be disclosed when and if necessary to ensure the safety of the members of the college. However, any information that is shared will be done with the utmost respect for privacy and sensitivity. In lieu of your signature, the submission of this form will indicate your agreement with this declaration.
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