University of Pittsburgh at Johnstown
Sexual Assault Anonymous Reporting Form
Read and complete the form and send to:
Pitt-Johnstown Chief of Police – Campus Police Suite, Physical Plant Building, Johnstown, PA 15904
Read this before completing the form:
is intended for the anonymous and confidential reporting of sexual assault and rape.
was designed to allow survivors of sexual violence – as well as others with whom they discuss these
incidents – to bring the misconduct to the attention of the University. Data collected from this form will help us
better understand the extent of the problem, plan more effective prevention and response efforts, and create a safer
The form is one option for reporting sexual assault or rape. Completion of this form does not initiate a police
investigation or judicial action. However, if it is determined that there is an ongoing threat to the campus
community the University is obligated to investigate such incidents, especially those involving weapons or multiple
alleged victims. Survivors who complete this form may choose whether or not they also wish to file a police report
or pursue judicial action.
Anyone can s
ubmit a form on behalf of themselves or a survivor. The form should only be completed with
the knowledge and permission of the survivor. Only information reported by the survivor, resources
provided to the survivor, and behavior observed in the survivor should be reported on this form. This form
is not intended as a checklist to interview the survivor.
completing the form, please note that the form:
• May be submitted anonymously
• Will be held in the strictest confidence possible. All information contained on this form will be
kept confidential except in the case of an ongoing threat to the community that the University is
obligated to address. All efforts will be made to protect the survivor’s anonymity; no information
should be included which might identify the survivor unless explicitly requested by the survivor.
• Will be used in the compilation of statistical reports in compliance with federal law.
Student health and safety are primary concerns of the University of Pittsburgh at Johnstown. Sexual assault and
rape are crimes of violence and control, using sex acts as a weapon. Many on and off-campus resources are
available to assist survivors of sexual assault and rape. We strongly encourage all survivors to seek help.
This is NOT
a police report.
To file a police report, contact the Pitt-Johnstown Police Department at 814-269-7005
Anonymous Reporting Form 1