Title IX Incident Report Form

This reporting tool is for non-emergency incidents only. For emergencies or matters that need immediate attention, call 918-876-2529 or dial 911. The non-emergency number for Campus Safety is 918-335-6206 or email at security@okwu.edu.

Oklahoma Wesleyan University takes the reports made through this site seriously. Please make your report as accurate, complete, and truthful as possible. Every effort will be made to evaluate your report within two business days of submission, however, the timing and manner in which the University responds to the report will vary depending on the information provided and whether you wish to remain anonymous.

Name

First Last

Leave blank if Anonymous

Who was involved in incident?*

Who is/could be affected?*

Date of Incident*

Time of Incident

:

What is the primary concern?*

While you may have multiple concerns, please select the one that best describes your primary concern

Name and Contact Information of Involved Individuals, Organizations or Groups

INFORMATION ABOUT YOUR EXPERIENCE AND/OR OBSERVATIONS

Where did this incident take place?*

Please provide a detailed description of the incident using concise and objective language. If you have a desired outcome, please indicate details below.

What type of activity took place?

Select any that apply. If you are unsure which category/categories describe what you are reporting, please select 'Other or Not Applicable' from the list. Please provide as many details as possible in the previous question.

Please provide the police report number

We may wish to contact you to obtain additional information. Please remember that the timing and manner in which the University addresses the report will vary depending on the information provided and whether involved parties are available for further discussion. Do you consent to our contacting you, if needed? (Please select all that apply.)

You may contact me
I wish to remain anonymous to involved individuals, but you may contact me
I am filing this report on behalf of another individual(s), who may be contacted
I am filing this report on behalf of another individual(s), who does not want to be contacted
Please do not contact me

Please list your phone number or email address, in the event that we need to contact you.

If you wish to remain anonymous or do not want to be contacted, please enter 'anonymous' or 'do not contact me' in the blank.