Sexual Assault Anonymous Reporting Form

Using the following form, student victims/survivors of sexual assault may file an anonymous report with the Office of Student Conduct, whether or not the victim of a sexual assault decides to file disciplinary and/or legal charges against the offender at a later date.

There is not a statute of limitations on filing complaints within the Office of Student Conduct. If you later decide to file disciplinary and/or legal charges, you may initiate this process by contacting the Office of Student Conduct, Shane Hansen, at (580) 327-8418; NWOSU Campus Police at (580) 327-8511; or the Title IX Coordinator, Calleb Mosburg at (580) 327-8415.

To keep information anonymous, do NOT include names of victim or perpetrators. If names are included, this is no longer considered an anonymous report and an investigation may be conducted by NWOSU Campus Police and the Office of Student Conduct, respectively.

Please select the appropriate answer to each question. Then, follow the directions at the end of this form.

Information about the Victim/Survivor

Information about the Assault

Type of Coercion/Force - check all that apply *
Reported Assault - check all that apply *

Information about the Offender(s)

Sex of Offenders *
If multiple offenders, estimated ages - check all that apply
Relationship of Offender(s) to the person assaulted - check all that apply *

Plans for Follow-Up Actions

Northwestern Oklahoma State University

709 Oklahoma Blvd., Alva, OK 73717
Phone: (580) 327-1700

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