Anonymous Sexual Assault Form

This form is for reporting a sexual assault anonymously to the MIT Police Department. A victim/survivor may complete this form themselves and send it to the MIT Police Department, or a victim/survivor may ask a third party (such as a friend or counselor) to do so.

You may submit an Anonymous Sexual Assault form on the web (click for link) or download the Word document to print and fill out off-line.

Please mail the completed form to:
ATTN: Captain Andrew Turco
MIT Police Department
565-570 Memorial Drive
Building W91
Cambridge MA 02139
Email the form to

While more information is useful for MIT Police purposes, you do not need to complete all questions in order to submit this form.


VPR is MIT’s primary, on-campus resource for preventing and responding to interpersonal violence, including sexual assault, dating and domestic violence, stalking, and sexual harassment. Our prevention specialists work with the entire campus to educate and raise awareness. Our advocates provide emotional support and assist survivors in deciding what to do next. VPR’s confidential hotline is available 24 hours a day at 617-253-2300.

To learn more about MIT’s Policy on Sexual Misconduct visit

* The MIT Police Department is responsible for issuing timely warnings in compliance with the Jeanne Clery Disclosure of Campus Security Policy and Campus Crime Statistics Act (Clery Act), which requires colleges and universities to notify students and employees whenever there is a serious or continuing threat to the safety of members of the campus community. For more information, please refer to Chapter 6-12 in the Department of Education’s Handbook for Campus Safety and Security Reporting 2016 Edition.