University Police Sexual Assault Anonymous Report

All submissions will be kept confidential. All form questions are optional.

This form is for reporting incidents of sexual assault, dating violence, domestic violence or stalking anonymously to the Binghamton University Title IX Coordinator, to assist with the compilation of statistical records. In compliance with the federal Student Right to Know and Campus Security Act, submitting this form will not result in an investigation unless requested, although Title IX staff may reach out to known/named victims to offer supportive resources. A person who has been assaulted may fill out this form themselves or may ask a third party (such as a friend or a counselor) to do so. If a victim needs immediate assistance, call University Police at (607) 777-2222 or 911 from a campus phone.

University personnel other than those with significant counseling responsibility (such as licensed professionals or certified counselors) must file a report when informed by a student of a sexual assault, to maintain compliance with the Federal Crime Awareness Act.

Victim Information
Incident Information
Incident Location
Does the victim plan to seek Criminal Prosecution or Binghamton University disciplinary action against the offender(s)? (Check All That Apply)
What resources has this person used thus far? (Check all that apply)
Person Submitting Form (Optional)
Would you like to be contacted by the Title IX Office?
If you would like to be contacted by the Title IX Office, please provide your email address in the above field.