***ALL INFORMATION IS CONFIDENTIAL***
The information you provide on this form WILL NOT be released to anyone without your prior consent. The Rape Action Committee will only use these reports to compile and tabulate statistics. The 10 minutes taken to fill out this form will expose and help stop sexual harassment and rape at UF, SFCC, and in the community. Please feel free to contact us if you have any questions or concerns, phone (352) 372-2361 or (352) 371-1403, e-mail campus_now@hotmail.com.
Print out this survey and mail it to Campus NOW at 1021 W. University Avenue, Gainesville, FL 32601.
Or copy the text below into an email, and send results to campus_now@hotmail.com.
Have you ever been raped on UF Campus? Yes No (if no, please pass on the survey to someone who has)
Have you ever been sexually harassed on UF Campus? Yes No (if no, please pass on the survey to someone who has)
Today’s date: _ _-_ _-_ _ Date of incident: _ _-_ _-_ _
What is your gender? ___________
Your date of birth: _ _-_ _-_ _
Are you a student? (circle): Yes No If yes, school and classification:_________
Are you a UF or SFCC employee? (circle) yes no
If so, give school, title, or dept.: _____________________________________________
Sex of the offender? (circle) F M Age of the offender: ________________
Is the offender a UF or SFCC student? (circle) Yes No Unknown
If yes, which school? ____________________________________
Is the offender a UF or SFCC employee? (circle) Yes No Unknown
If yes, give school, title, or dept:_____________________________________________
Does the offender have any other affiliations? (e.g. organizations, fraternities, sports, etc.) If yes, please list: ________________________________________________________
Is this the first offense this person has committed against you? (circle) Yes No
Have you reported this person to the University or to law enforcement? (circle) Yes No
If so, to whom? _________________________________________________________
Is this incident still under investigation? Yes No
Were you satisfied with the way you were treated by UF/UPD/GPD?________________
If not, why not? __________________________________________________________
Were you satisfied with the outcome? ________________________________________
If applicable, how long did it take for the situation to be resolved? __________________
During the reporting process, how many different people did you have to deal with? _______________________________________________________________________
Is the harassment still persisting? ____________________________________________
Describe the incident with as much detail as you are comfortable. Attach additional sheets as needed. Please include any additional information about the offender (previous incidents, continuing harassment, etc.) and about any other report(s) you filed (process and outcome). If you did not file a report, please explain why not (Most women who are raped and harassed do not file reports. It will help us to know why).