DeSales University Logo

Sexual Violence Reporting Form


Forms are typically reviewed within 1 business day. Do not use this form to report events an emergency and/or immediate threats to life or property. if you require emergency assistance, please contact Campus Police direct dial at 610.282.1002 OR x1250 from any campus phone OR dial 911.

 

To speak with a confidential resource 24 hours a day, please contact the Crime Victims Council of the Lehigh Valley at 610-437-6611. 

 

Please only use this form to report incidents of Sexual Assault, Dating Violence, Domestic Violence, Stalking, or Sexual Exploitation 

 

 To report incidents of discrimination, protected class harassment, and bias please fill out this form.

Anonymous reporting may limit the university's ability to follow up on a report. When a complainant (a person targeted by the alleged conduct) is identified in a report and a member of the university community, the Title IX Coordinator (or designee) will contact that individual to schedule a meeting to discuss resources available to that individual and the university's grievance process.

 

Questions you may have:

Q: When should I fill out this form?

A: When you wish to report an incident or incidents of sexual assault, dating violence, domestic violence, stalking, or sexual exploitation. 

Q: There are multiple forms listed above, what if I fill out the wrong one?

A: Do not be concerned if you fill out the wrong form. Administrators work collaboratively and if a report is better addressed by another office, the information will be shared as needed.

Q: Can I fill out the form anonymously?

A: You can fill out the form anonymously. Depending on the information shared, the University may be limited in the response and follow-up it can do.

Q: Who is going to see the information I fill out?

A: The information provided in these forms is typically shared with the Title IX Coordinator, the Deputy Title IX Coordinator, and members of the DeSales Police and Public Safety Department. It may be shared with additional administrators as needed, while taking into consideration the privacy rights of all individuals involved, to appropriately address the situation.

Q: Will I hear back from someone?

A: You may be contacted about the information you have entered into the form as long as you provide contact information. The individual who has been identified as being targeted by the alleged behavior, when identified, will also be contacted in most instances.

Q: Do I get a copy of my report?

A: You will automatically be sent a copy of your report as long as you enter a valid email address and do not select out of receiving a report at the bottom of this page. If you do not list an email address, a report cannot be shared with you. Besides a copy of the report, you will also receive information regarding resources, policies, and administrators you may wish to contact.

Q: Where can I find a copy of the University's policy?

A: You can find a copy of the policy by clicking here

If you have additional questions or wish to contact someone directly, please email Tom Johnson, Title IX Coordinator at thomas.johnson@desales.edu.

Background Information

Anonymous reporting may limit the University's ability to follow up on a report. If you wish to receive a copy of this report, you must supply a valid email address. 

 
Learn more
Optional
Learn more
Student, Faculty, Staff, Visitor, Other...
Learn more
Optional
Email address must be of a valid format.
Learn more
Optional. Please note that you must fill this out to receive a copy of the report.
Learn more
This can be your on-campus or off-campus address
This field is required.
Learn more
Please pick the choice that you feel is most accurate.
This field is required.
Learn more
If you do not know the date of the incident, put the current date
Learn more
Optional
This field is required.
Learn more
Example: Room number or Apartment Number

Involved Parties

Please read before entering the information below. 

 - If known, please provide contact information for the individuals

- If no identifying information is known, please provide information that may lead to the person's identification, such as a physical description, connection to DSU, and those with whom the person associates in the incident description box. 

- If you can add names to the report by clicking on the 'additional identification' text box to provide information.

 

Definition of Roles:

 

Complainant: The individual who experienced the alleged behavior. When a complainant (a person targeted by the alleged conduct) is identified in a report and a member of the university community, the Title IX Coordinator (or designee) will contact that individual to schedule a meeting to discuss resources available to that individual and the university's grievance process.<

 

Respondent: The individual who engaged in the alleged behavior.

 

Witness: An individual who has a first-hand account of the alleged behavior.

 

 Bystander: An individual who has a first-hand account of the alleged behavior and who tried to intervene to stop the alleged behavior.

ls named.

 

Involved party 1

Questions

This field is required.
How would you like to be contacted about this report?(Required)
This field is required.
Have you reported this incident to the Office of University Police or another police department?(Required)
This field is required.
Did you report this incident to Residence Life?(Required)
This field is required.
Has this incident impacted your education or employment at the university?(Required)
This field is required.

Supporting Documentation

Please attach any relevant documentation. By clicking the submit button below, this report will be automatically sent to DeSales University's Title IX professionals, Title IX Coordinator Tom Johnson, and Deputy Title IX Coordinator Gracia Perilli. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission