Reporting Form for Sexual Assault, Sexual Violence and Sexual Harassment

  • We strongly encourage all survivors of (or witnesses to) sexual assault, violence or harassment to report the incident to the police, and/or to avail themselves of any/all of the resources listed in our sexual assault and sexual violence policy, appendix II and III:
    http://michener.ca/discover-michener/policies/sexual-assault-and-sexual-violence-policy/

    Why would I fill out this form?

    This information will be used to help enhance understanding of our campus climate so that we may strengthen sexual violence response and prevention efforts, as well as for statistical purposes.
    Survivors can also use this form to request support. Survivors who may not initially be inclined to report a sexual assault to the police or to Michener have the right to change their mind at any time. Information the student provides on this reporting form can be used at any time should the survivor so choose.

    What happens with this information?

    Tracking this information allows Michener to make decisions concerning the safety of individuals on campus. For the survivor it allows Michener to determine if the appropriate supports are in place and likewise the reporting form provides Michener with the information needed to take disciplinary action where warranted against the offender and/or the associated group (e.g. club, organization).

    PLEASE NOTE: Completing this form does not constitute a police report or a student conduct report. You cannot be identified in submitting this form as it is sent from a ‘site admin’ address and all Information is collected in accordance with The Michener Institute's Privacy Policy and the Freedom of Information and Protection of Privacy Act. For this reason you will NOT be contacted by Michener unless you indicate a desire to be contacted on this form.

    What if I would like to speak with a person or require assistance filling in this form?

    Please contact any of the persons/departments listed:

    Manager, Student Success Network at 416-596-3141
    Director, Human Resources at 416-596-3101 ext 3497
    Counseling Office at 416-596-3101 ext 3468
    Security at 416-596-3101 ext 3333
  • Please leave this section blank if you do not wish to be contacted

  • I (the person making this report) would like to be contacted by someone from Michener. I can be reached by:
  • Reporter's Information

    (the reporter and survivor can be different people)
  • (OPTIONAL)
  • Survivor's Information

    (the reporter and survivor can be different people)
  • (OPTIONAL)
  • (OPTIONAL)
  • Offender(s)' Information

    Note: If an offender(s)' name or group affiliation is listed, the institution may take action with the offender(s) or group.
  • Assault Information

  • :
  • Other Reports

  • Description of the Incident