Online Report of Sexual Harassment, Sexual Violence, Dating / Domestic Violence or Stalking
You have the option to fill in your contact information or submit the report anonymously. Depending on the amount of information disclosed, the University’s ability to investigate and respond to the report may be limited
Reports submitted through this site are not monitored 24 hours or when the University is closed, including weekends. Do not use this reporting form if an immediate response is required.
If you or any other person is in immediate danger, DO NOT use this reporting site! Call 911 or if the emergency is on the UMHB campus, contact the UMHB campus police at 254-295-5555.
What is your relationship to the incident?
*
I am the victim
I witnessed the incident
The victim reported the incident to me
Other
Where did the incident(s) occur? (check all that apply)
In a public space on campus
In a campus classroom
In campus housing
At a campus event
In a university employee’s office
At a campus recreation or athletic facility
While working at a campus job
During an off campus clinical or internship experience
Online/Social Media
Off campus (community setting, private residence, etc.)
Other
When did the incident(s) occur? Please be as specific as you can. Do you know the date? Month? Season? Year? If you are reporting multiple incidents, provide a range (for example “Fall of 2021 until now”).
Please describe the incident as completely as possible. Include what led up to the incident and what happened. What was said? What happened after the incident? Who was responsible for the incident, including names or job titles if you know them. Were others present - students, friends, faculty, staff, etc.? (You will have the opportunity to include their names below if you want to.)
Did incidents like this occur more than once?
Yes
No
If you want to provide names and contact information for anyone who witnessed the incident(s) or may have information about it, please include that here. This information may include first and last name, and status (student, employee, etc.,) and contact information if known.
Do you have any supporting documentation?
Yes
No
If you wish to submit supporting documentation (documents,photos, texts, emails, social media screen shots, etc.)
Browse Files
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I am a:
*
Current student
Former student who left UMHB prior to graduating
UMHB alumnus
UMHB employee
I prefer not to respond
Other
Have you been personally affected by the incident? (check all that apply)
Yes, my academic performance, academic opportunities and/or learning environment have been affected
Yes, my ability to participate in a university-sponsored event or program has been affected
Yes, my university employment has been affected
No, the incident did not really affect me
What would you like to see happen as a result of your report?
*
Why are you submitting this report?
*
Information Only – I want to make an anonymous complaint.
I want to talk with someone about this complaint. (please enter your name, phone number and email address)
I want the University to investigate and act on this complaint (Contact information is required below)
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Have you reported this incident to the police?
Yes, campus police
Yes, other police
No
I would like help reporting this to the police
Submit
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