This form is for reporting a sexual assault anonymously to the MIT Police Department. A person who has been assaulted may complete this form himself or herself and send it to the MIT Police Department, or he/she may ask a third party (such as a friend or counselor) to do so.

The MIT Police may use this information to determine whether MIT has a legal requirement to issue a timely warning to the MIT community, to assist with legally required statistical record keeping and to respond to any other legal obligation.

In completing the form, while more information is better for MIT police purposes, you do not need to complete all questions.