Sexual Assault Incident Report Form
The purpose of this form is to allow members of the UTA Community to anonymously report incidents of sexual assault. This report form is used to convey information that is needed to track the university's response to the incident being reported, as well as, to assess the danger that the incident may represent to the community at large. This form also assists in understanding the campus climate and planning a response to relationship violence. 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 Violence Prevention Program as soon as possible, preferably within 24 hours so that timely coordination of services is assured. For any questions, please contact Deanee Moran, Response and Prevention Coordinator at 817-272-0112.
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.