Incident Reporting Form

(Anonymous Reporting is Optional)

Thank you for reporting. If this is of life threatening nature or immediate care/response is needed, please contact police by dialing 911 and follow up with a call to Public Safety on the University campus at (651) 631-5310.

This is a secure reporting format accessible only to the Title IX and Public Safety office on the University of Northwestern - St. Paul campus. Submissions are not continually monitored and will be typically reviewed on the next business day. You are not required to complete the entire form in order for the incident report to be submitted; however, you must complete fields denoted with an asterisk. The University will use the information provided to address the complaint, which can include an investigation and contacting the parties involved. If the report does not contain specific information, the University’s investigation and response may be limited.

All reports may be submitted anonymously; however, if you are the victim/survivor reporting, please know that doing so may limit the University’s ability to address the matter and assist you. In addition to completing this report, the Title IX Coordinator can be reached at or

Off-campus resources: Sexual Offense Services (St. Paul), 651-266-1000,, RAINN (Rape, Abuse, and Incest National Network), 800-656-HOPE (4673) (24-hour hotline), Sexual Violence Center Minneapolis, 612-871-5111 (24-hour hotline).

On-campus resources: Title IX Coordinator | Meagan Buchholz | 651-631-5149 | | | Riley Hall 1605

Phone Number:
Approximate Time of Incident:
Location of Incident:
List of all Parties Involved:
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