Confidential Sexual Assault, Stalking, Domestic and Dating Violence Report Form
This form is for the purpose of collecting data to determine the number of incidents occurring within this community in order to comply with federal law and to develop appropriate resources.
INSTRUCTIONS
- This form is intended for the use in cases regarding rape/sexual assault, attempted rape/sexual assault, domestic/dating violence, or stalking.
- Do not complete this form in presence of assault survivor.
- Do not include the survivor’s name or other identifying information (e.g. student identification number, address, phone number) on this form.
- Record as much requested data as possible based on information volunteered or discussed. Do not pry for information, just list the information obtained in the conversation.
- Complete this form even if the survivor indicates that he or she has spoken with another person on campus and even if you will be referring the survivor to another department.
- Completed forms should be forwarded to Scott Forshee, Chief of University Police, 1500 University Drive, Billings, MT 59101. For immediate response (business and after hours), call (406) 657-2147.
Reported to (optional) / Date/Time reported / Date/Time incident occurred
For classification purposes – Please classify the incident by using the below legal definitions.
Sex Offenses / Rape Categories(Click to Select)Forcible FondlingIncestRapeStatutory Rape / (Click to Select)Forcible SodomySexual AssaultSexual Assault with an ObjectStatutory Rape
Dating Violence, Domestic Violence, or Stalking
(Click to Select)Dating ViolenceDomestic ViolenceStalking
General description of incident, (or attempted), including whether or not reported to anyone.
______SURVIVOR INFORMATION / ASSAILANT INFORMATION
Male Female Student Non-student Student Status (Click to Select)FreshmanSophmoreJuniorSeniorGraduate Student
Resident Commuter / Male Female Stranger
Acquaintance Student Non-student Resident Commuter # of Assailants
Location of Incident / Hate Crime Related Yes No
Check that which applies to where the incident occurred
University - owned, controlled, or leased property? Yes No
University - sponsored activity or event? Yes No
Was either of the persons under the influence of alcohol at the time of the incident?
SURVIVOR ASSAILANT BOTH NEITHER
DEFINITIONS FOR CLASSIFICATION PURPOSES:
(Enter the correct classification of the incident you are reporting)
Sex Offenses: Any sexual act directed against another person, forcibly and/or against that person’s will: Or not forcibly against the person’s will where the victim is incapable of giving consent.
Forcible Fondling: The touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against that person’s will: Or, not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent or mental physical incapacity.
Statutory Rape: Non-forcible sexual intercourse with a person who is under the statutory age of consent.
Incest: Non-forcible sexual intercourse between persons who are related to each other within the degrees wherein mirage is prohibited by law.
Rape: The carnal knowledge of a person, forcibly and/or against the person’s will: Or not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her temporary permanent mental or physical incapacity(or because of his/her youth).
Forcible Sodomy: Oral or anal sexual intercourse with another person, forcibly and/or against that person’s will: Or not forcibly against the person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical capacity.
Sexual Assault with an Object: The use of an object or instrument to unlawfully penetrate, however slightly, the genital or anal opening of the body of another person, forcibly and/or against that person’s will: Or not forcibly or against the person’s will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent or mental physical incapacity.
Dating Violence: Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim and, where the existence of such a relationship shall be determined by the victim with consideration of the following factors:
(1)the length of the relationship,
(2)the type of relationship,
(3) the frequency of the interaction between the persons involved in the relationship.
Domestic Violence: Includes felony or misdemeanor crimes of violence committed by a current or former spouse of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or by any other person against an adult or youth victim who is protected from that persons acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred.
Stalking: A course of conduct directed at a specific person that would cause a reasonable person to fear for her, his, or others' safety, or to suffer substantial emotional distress.
Hate Crime: Defined as a criminal offense committed against a person or property which is motivated, in whole or in part, by the offender’s bias. Bias is a preformed negative opinion or attitude toward a group of persons based on their race, gender, religion, national origin, sexual orientation, gender identity, ethnicity or disability. For Clery Act reporting purposes, hate crimes include any offense in the following list that is motivated by bias:Murder and Non-negligent Manslaughter, Sex Offenses, Robbery, Aggravated Assault, Burglary, Motor Vehicle Theft, Arson, Destruction/Damage/Vandalism to Property, Intimidation, Larceny/Theft, Simple Assault Hate Crime Bias, Race, Religion, National Origin, Sexual Orientation, Gender Identity, Ethnicity, and Disability.
Definitions from the National Incident-Based Reporting System Edition of the Uniform Crime Reporting Program
UPD Form 108.1.2 Revised: 04/12/15