Sexual Harassment and Discrimination Anonymous Report Form

Why use this form?

This form is available for anonymously reporting incidents of harassment, including, but not limited to sexual violence and discrimination that you believe may be a violation of Bethany College’s Title IX/Sex Discrimination Policy. Reports can also be made directly to the Title IX Coordinator by phone at (304) 829-7631 or by email at

Who should use this form?

This form can be used by any person making a report on his or her own behalf who wishes to remain anonymous. It can also be used by students and visitors wishing to anonymously file a report on behalf of another person. It is important to understand that if you choose to file an anonymous report, you may limit the College’s ability to remedy the problem.

If I am the employee, does completing this form satisfy my mandatory reporting obligation?

No. Anonymous reporting does not satisfy the mandatory reporting obligation. Please complete the Sexual Harassment and Discrimination Incident Report Form.

What happens after I fill out this form?

The information is sent to the Title IX Coordinator, who will determine what, if any, action by the College is necessary. You will ordinarily receive a follow-up message from the Title IX Coordinator within three business days.

Is the information in this form confidential?

The College will make every effort to protect the privacy of all involved, but the information you provide in completing this form is not confidential and may be shared as necessary for the College to take the appropriate action.

Do not use this form to report events presenting an immediate threat to life or property. If you require emergency assistance, please contact Campus Safety and Security at (304) 829-7744.

Anonymous Report Form


Be as specific about what happened as possible, including information about the people involved. If the complainant/victim has not consented to having his/her name revealed, do not use any real names or provide any other identifying information in your description. Instead use language like the following: "Jane Doe reported to me that on June 5, 2013, John Doe..." Otherwise, feel free to use real names. Please include all pertinent facts, behaviors, comments, gestures, markings, clothing, or other distinguishing characteristics.

Victim Information

Alleged Perpetrator Information