Sexual Misconduct Reporting Form

Reporter Information

If you wish to identify yourself, please fill in the information listed below.

If the person completing this form is the victim, you may choose to identify yourself or not.

If you are a third party reporting source (not the victim), include your information below, and include the victim's information in the "Involved Parties" section.

Reporter's Name:

Reporter's Position/Title:

Reporter's Phone Number:

Reporter's Email Address:

Reporter's Physical Address:

Type of Complaint:

Urgency of this Report:

Involved Parties

Please identify the person(s) involved in the incident below, including their full names, student ID numbers, and roles. Roles include victim, alleged, witness, or other. *If multiple individuals are listed, include each on a separate line.

Incident Information

While providing details is essential to investigating your complaint, please be advised that some or all of the information you provide in this section may be shared with the person(s) you are accusing. You may supplement this description later if you wish to share additional details later.

Date of Incident:*

Time of Incident:

Location of Incident:*

If on campus, what building/location:

Specific room number (if applicable):

Describe the incident(s)/event(s) in as much detail as possible, including date, times, locations, and any potential witness(es) to the incident.*

Describe the impact the behavior has had on you.*

Have you taken any action to stop the behavior?

Yes

No

If yes, what actions have you taken and what was the outcome?

What remedy are you seeking (no contact, restrictions/limitations, removal, etc.)?*

Supporting Documentation

Please email any supporting documentation to titleIXcoordinator@lsue.edu. Supporting documentation can include police reports, pictures, screenshots, emails, etc.

Sexual Misconduct and Sexual Harassment Reporting Form

In the event of an EMERGENCY, please do not use this form.
Call LSUE Police (337-550-1225) or call 911.

Sexual Misconduct and Sexual Harassment Reporting Form

In the event of an EMERGENCY, please do not use this form.Call LSUE Police (337-550-1225) or call 911.

In the event of an EMERGENCY, please do not use this form.
Call LSUE Police (337-550-1225) or call 911.