ONLINE REPORT FORM
This is not a formal document and no criminal
investigation can occur without authoriztion from the victim.
Date of Report:
Is this report based on information that is:
first-hand (you are the survivor, a witness or participant)
second-hand (you were told by the survivor, witness, or participant)
third-hand (you heard about it from someone else)
Date and time of assault:
Location of assault:
Is the survivor
Is survivor an ISU student?
Survivor's approximate age:
Does the survivor know the assailant?
Description of assault:
(what happened, injuries, weapons involved, car, etc.)
Is the assailant an ISU student?
Description of assailant:
(e.g., name; sex; height; weight; age; coloring [skin, hair, eyes]).
Has the assault been reported to other agencies?
If so, which agencies?
Was the survivor in need of medical attention?
If yes, did the survivor receive medical attention?
Has the survivor received counseling?
I would be willing to talk to
confidentially to someone about this.
If yes, name
Phone number
Additional Comments:
