MTSU Campus Recreation Harassment Report
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We are sorry you experienced an incident at the Rec Center, and appreciate you taking the time to complete this form. All matters are viewed within a timely manner and taken seriously.
You have the option to include your name and contact information if you would like, or can submit anonymously.
If you are reporting multiple incidents, please complete a new report for each different day/time an incident occurred, even if it was with the same offender.
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Date incident occurred:
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Time of incident:
If exact time is not known, please include estimate (such as early morning, or an approximate time range).
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Location of incident:
(add all that apply to this specific incident)
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Location if "other" was selected:
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Location if "other" was selected:
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Location if "other" was selected:
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Incident Description
Please provide a detailed description of the incident that occurred, including events leading up to the event, what occurred, responses of either party, etc.
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Offender Description
Please provide as many details about the offender you are able to, such as their name (if known), clothing, approximate height, etc.
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Optional: Contact Information of Person Reporting
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All fields are optional.
Any/all can be left blank if you do not wish to provide the information.
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Your name:
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M number:
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Email:
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Phone number:
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Year/Affiliation
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