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Anonymous Sexual Violence Report Form

ANONYMOUS REPORT FORM: Sexual violence, Sexual Assault, Rape, Sexual Harassment Domestic Violence, Dating Violence, Stalking

NOTE:  Doane University employees, including student staff, may be required to report to the Title IX Coordinator ([email protected]) or the Public Safety Office ([email protected]) if they receive notice of an incident of Sexual Violence, Sexual Assault, Rape, Sexual Harassment, Domestic Violence, Dating Violence, or Stalking. Employees, including student staff, are only required to report if you are identified as a “Responsible Employee”. Please see the full policy to determine which type of responsibility you have. Doane University takes all forms of sexual violence and harassment seriously.  If you as a student or employee survivor or reporter wish to remain anonymous, fill out this Anonymous Report Form. Doane University will use this information for statistical purposes, to better understand the scope of sexual violence on campus, and to develop and implement preventive efforts. If you fill this form out with a Doane University employee, including a student employee, the report will no longer be anonymous.

Doane University is required to investigate allegations of sexual misconduct to the best of its ability.  As a result, Doane University will follow up on any specific, identifying information provided in this anonymous report. If you wish to discuss a concern, while maintaining confidence to the greatest extent possible, you have the following options:

To submit an anonymous report of sexual violence please fill out the form below to the best of your ability, and submit. Please note that some questions ask you to check all the answers that apply, so you may make more than once selection.


  • Complainant: an individual who is alleged to be the victim of conduct that could constitute sexual violence, sexual assault, rape, sexual harassment, domestic violence, dating violence or stalking.
  • Respondent: an individual who has been reported to be the perpetrator of conduct that could constitute sexual violence, sexual assault, rape, sexual harassment, domestic violence, dating violence or stalking.


Incident Information

Complainant Information

Respondent Information

of any kind and in any form that interferes with the academic or employment experience because it has created an intimidating, hostile or offensive environment
which means a course of conduct directed at a specific person that would cause a reasonable person to fear for their own or other's safety, or to suffer substantial emotional distress
includes asserted violent misdemeanor and felony offenses committed by the victim's current or former spouse, current or former cohabitant, person similarly situated under domestic or family violence law, or anyone else protected under domestic or family violence law
which means violence by a person who has been in a romantic or intimate relationship with the victim. Whether there was such relationship will be gauged by its length, type, and frequency of interaction
exposing one's genitals, flashing, mooning

Non-Anonymous Reporting

If you wish for the Doane University to investigate the matter you are reporting, please report the matter to the Doane University Safety Office(402)826-8669 or the Title IX Coordinator (402)826-8118. Once you contact these offices or disclose identifiable information to a Doane employee or student staff member, Doane University will have a duty to investigate based on available information.