This form may be used to report any act of sexual misconduct that should be reported to Rensselaer. This form is anonymous, but you may optionally include personally identifiable information in the fields below. Anonymous Complaints You have the right to file an anonymous complaint. However, Rensselaer’s ability to investigate and respond to the conduct may be limited. Recognizing that Rensselaer has a legal obligation to review all reports, the Institute will weigh such factors as the seriousness of the alleged conduct, whether there have been other Complaints of a similar nature against the same Respondent, and the Institute’s commitment to provide a reasonably safe and non-discriminatory environment. Rensselaer will determine if it is necessary to proceed with an investigation or implement other appropriate remedies. * required field Incident Information The Accused is: * a Rensselaer student a Rensselaer employee (faculty or staff) Unsure Date incident occurred: * Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Day Day12345678910111213141516171819202122232425262728293031 Year Year1977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019 Time incident occurred: * Hour hour123456789101112 : Minute minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859 am pm Location of incident (building name or address): * Brief Description of incident: * Please describe to the best of your ability what happened. Did the incident occur in a building or on the street? * Building Street Did the incident occur on University-owned, controlled or leased property? * Yes No Did the incident occur at a University-sponsored activity or event? * Yes No Name(s) of Accused: (optional) Name(s) of witnesses: (optional) Contact Information (OPTIONAL) Your Name Your Email Your Phone Number Your Relationship to Rensselaer Other Comments Generate a new captcha What code is in the image? * Enter the characters shown in the image.