Sexual Assault Anonymous Report

This form is for reporting a sexual assault anonymously to Old Westbury University Police, to assist with the compilation of statistical records for assaults that occur on the campus. In compliance with the federal Student Right to Know and Campus Security Act. Filing this form will not result in an investigation. A person who has been assaulted may fill out this form himself or herself and send it to University Police or may ask a third party (such as a friend or a counselor) to do so.

Campus personnel other than those with significant counseling responsibility (such as licensed professionals or certified counselors) must file a report when informed by a student of a sexual assault, to maintain campus compliance with the Federal Crime Awareness Act.

Please complete the form below.

Sexual Assault Anonymous Report
Specify AM/PM
If available
Information on the Victim/Survivor
Information on the Assault
Check all that apply.
Check all that apply.
Check all that apply.
Information on the Offenders
Check all that apply.
Check all that apply.
Follow-Up
Person Making Report
Optional
Optional
Optional