Online Survey Software | Qualtrics Survey Solutions

Sexual Misconduct and Gender Based Violence Report Form
This form is used to report incidents of sexual misconduct or gender based violence at Bowdoin. Please fill this out with only the information you have or are willing to share. All questions are optional and you may choose to answer only the questions you are comfortable with. You may also choose to remain anonymous. If you do not provide contact information, the report is used for statistical purposes.

Reports are sent to Benje Douglas, the Director of Title IX and Compliance. For more information on what happens when you submit a report, visit the Reporting page on Bowdoin's Title IX Website.

Reporter's Information
The reporter and the survivor may be different people.

Would you like to report this incident anonymously?
If you provide contact information you will be contacted by Benje Douglas, the Director of Title IX and Compliance, who will offer support and resources.

Yes, I would like to remain anonymous
No, I will provide my contact information

Reporter's Contact Information

First Name

Last Name

E-Mail

Phone Number

Survivor's Information
Note: If a survivor's name is provided, Benje Douglas, The Director of Title IX and Compliance, will contact that person to offer support, provide resources, and answer any questions.

I am the survivor
I am not the survivor
I prefer not to answer

Survivor's Contact Information

First Name

Last Name

E-Mail

Phone Number

Accused's Information

Note: If an accused's name or affiliation is listed, the institution will take action with the accused(s) or group. That action will include a meeting with a member of the Dean of Student Affairs staff and the Director of Gender Violence Prevention and Education. The meeting is used as an opportunity to educate the accused about expectations around consent and to explain about the Bowdoin Student Sexual Misconduct and Gender Based Violence Policy and Procedures. Putting down a name does not constitute a formal complaint. If you would like to make a formal complaint, or are interested in understanding your options, please contact Benje Douglas, the Director of Title IX and Compliance, at 207-721-5189 or bdouglas@bowdoin.edu.

First name

Last Name

Is there another Accused person?

Yes
No

List the additional Accused here, along with their affiliation (i.e. student, faculty, staff, not affiliated, or other)

Incident Information

Enter the date and time of the incident.

Enter a date:

Previous Month (May 2025) June 2025 Next Month (July 2025)
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	1	2	3	4	5
6	7	8	9	10	11	12

Enter a time

Nature of the Incident:

Penetrative
Non-penetrative
Prefer not to answer

Was the survivor given alcohol or drugs without consent or knowledge?
Note: The survivor of a sexual assault will generally not be held accountable for policy violations related to alcohol or drug usage. Refer to the Student Sexual Misconduct and Gender Based Violence Policy for more information.

Did the survivor feel pressured to consume or use?

Yes
No

Please provide any additional information that you think would be helpful:

I (the person filing this report) would like to be contacted by someone from these Bowdoin College offices (check all that apply):

Health Center
Counseling Center
The Office of Gender Violence Prevention and Education
Women's Resource Center
Resource Center for Sexual and Gender Diversity
Office of Religious and Spiritual Life

Please contact me via:

Phone:

E-Mail

Click the arrows to submit this report.

Previous Month (May 2025) June 2025 Next Month (July 2025)
Su	Mo	Tu	We	Th	Fr	Sa
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	1	2	3	4	5
6	7	8	9	10	11	12

Previous Month (May 2025) June 2025 Next Month (July 2025)
Su	Mo	Tu	We	Th	Fr	Sa
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	1	2	3	4	5
6	7	8	9	10	11	12

Previous Month (May 2025) June 2025 Next Month (July 2025)
Su	Mo	Tu	We	Th	Fr	Sa
1	2	3	4	5	6	7
8	9	10	11	12	13	14
15	16	17	18	19	20	21
22	23	24	25	26	27	28
29	30	1	2	3	4	5
6	7	8	9	10	11	12