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File a Report

All efforts must be made to maintain the victim's anonymity; no information should be included which might identify the victim, unless the victim asks you to do so. Please return this form to the RVSP Program as soon as possible, preferably within 24 hours so that timely coordination of services is assured. For any questions, please contact an RVSP Coordinator at 817-272-9250.

If you have been sexually assaulted in the past, you still have options available to assist you.

Regardless if the sexual assault occurred last week, last month, or last year, you can still get help to deal with this assault and there are still options available for you to pursue.

The RVSP Coordinator on campus can assist you in reviewing the options you have and making referrals to appropriate agencies when needed. You can utilize one or all of these possible services. Some options you may want to pursue include:

  • Filing a report with the UTA Campus Police, Arlington PD or other Police Departments
  • Pursuing campus and judicial intervention
  • Academic or administrative intervention - altering academic schedules or housing arrangements if necessary
  • Medical care for treatment of sexual assault related injuries
  • Psychological care for sexual assault related trauma and experiences and your emotional well being
  • Legal assistance or referral, if necessary

*Unresolved feelings and experiences stemming from this assault can impact future recovery and have long term consequences if never addressed. No matter how long ago the assault took place, please call Counseling Services at 817-272-3671 or Mental Health Services at 817-272-2771 or the local Rape Crisis Center at 817-927-2737or the National Sexual Assault Hotline at 1-800-656-HOPE to seek help. Possible long-term psychological effects of sexual assault may include:

  • Rape Related PTSD
  • Rape Trauma Syndrome
  • Eating Disorders
  • Panic Attacks
  • Obsessive Compulsive Disorder
  • Flashbacks


Report Forms

Please Note: Completing this form does NOT constitute a police report nor a student conduct report. You will not be contacted by the Violence Prevention Program Coordinator unless you indicate a desire to be contacted.

Intimate Partner Violence Report

Sexual Assault Report

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