Sexual Assault Anonymous Reporting Form

(For best results, please fill out this form using the Google Chrome Browser.)

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 at (580) 327-8418; NWOSU Campus Police at (580) 327-8511; or the Title IX Coordinator, Calleb Mosburg at (580) 327-8415.

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 Offender *
Relationship of Offender 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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