Student Services Forms

Sexual Assault

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You can find more information about Texas Tech University's policies and procedures regarding sexual misconduct at:


Please fill out the following to the best of your ability, and do not hesitate to contact university administrators if you have questions or if you would like to make a report in person. We are here to help. You can contact us from 8 a.m. - 5 p.m. at (806) 742-SAFE (7233). You will be contacted within 24 hours of receipt of this report to discuss. If it is after hours and you need immediate assistance, please contact the Texas Tech Police Department at (806) 742-2000.

Background Information
Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled SID (Student ID #) if available.

About the Incident

In order for TTUHSC to effectively investigate the incident, we need to know as much about what happened as possible.

The information you provide will be kept confidential and shared only with necessary and essential student affairs administrators. During the course of the investigation process, this information may be shared with the alleged perpetrator. However, this will not occur without first consulting with the victim as to his or her preferred approach to handling the situation.

* Describe the incident(s) or event(s), including date, times, locations, and any potential witnesses to the behavior. Please include as much detail as possible.


If you are the victim of misconduct, please describe how you would prefer the University to respond to the situation. (You will not be held to this response; it just gives us a starting point.)

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. Maximum 12 megabytes per file attachments require time to upload, so please be patient after you click to submit this report.

One last step...

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