Confidential Report Form for
Sexual Misconduct, Dating/Relationship Violence, and Stalking

Please read all instructions and information on this page carefully.

Thank you for reporting. Your safety is of the utmost importance to us. If this is an EMERGENCY, immediately call 911 and/or contact Campus Security at 507-344-7888. Contacting police does not require you to pursue legal action.

This form is intended for use by students, employees, faculty, vendors, visitors or other concerned parties to informally or anonymously report specific information related to incident(s) of sexual misconduct, dating/relationship violence and/or stalking. Sexual misconduct includes, but is not limited to, harassment, assault, and exploitation of a sexual nature.

This is a secure reporting form. Submissions are accessible only by Bethany Lutheran College's Title IX Coordinator, Estelle Vlieger. She may also be contacted at; however, email is not a secure method of communication and should not be used for reporting incidents.

Submissions using this form are not continually monitored and will typically be reviewed on the next business day.

The information you provide on this form will be used to address the complaint, which can include an investigation and contacting the complainant, respondent and/or any potential witnesses. If the report does not contain specific information, the college's ability to respond and investigate will be limited.

Maintaining Your Anonymity

Some information about your computer or device is collected every time you visit any page on the internet. We regularly discard this information, and we do not attempt to identify users based on their submissions to this form except as may be required by law or court order. Please note that remaining anonymous may limit the college's ability to address the matter and assist you.

If you wish to remain anonymous, follow these guidelines:


Personal Identifying Information

If you are a victim/survivor, you may choose whether to identify yourself in this section; however, remaining anonymous may limit the college's ability to address the matter and assist you.

If you are a third party complainant who is not the victim, record your information below and record the victim's name and contact information in the "Individuals Involved" section.

Please provide identifying information about each individual involved in the incident. Do NOT include the name or identifying information about the victim/survivor without permission. Include each individual's name, role in the incident (alleged, victim, witness, respondent, complainant, etc.), and any identifying and contact information you know such as their phone number, email, mailing address or residence hall room number, Bethany ID number, and date of birth.

Incident Details

Please indicate the date, time, and location of the incident. If you are uncertain of the location name, consult our campus maps. In the Specific Location field, provide additional location information such as a room number or specific off-campus location.

Please provide a detailed description of the incident/concern using specific, concise, and objective language.

Incident Categorization

Policy definition: actual, attempted, or threatened sexual act without that person's consent that includes, but is not limited to:

  1. Involvement without consent in any sexual act in which there is force, expressed or implied, or use of duress or deception upon the victim. Forced sexual intercourse is included in this definition, as are the acts commonly referred to as "date rape" or "acquaintance rape." This definition includes coercing, forcing or attempting to coerce or force sexual intercourse or a sexual act on another.
  2. Involvement in any sexual act when the victim is unable to give consent.
  3. Intentional and unwelcome touching, or coercing, forcing, or attempting to coerce or force another to touch a person's intimate parts (defined as primary genital area, groin, inner thigh, buttocks, or breast).
  4. Offensive sexual behavior that is directed at another such as indecent exposure or voyeurism.

CONSENT is informed, freely given and mutually understood. If coercion, intimidation, threats, and/or physical force are used, there is no consent. If the complainant is mentally or physically incapacitated or impaired so that the complainant cannot understand the fact, nature, or extent of the sexual situation, there is no consent; this includes conditions due to alcohol or drug consumption, or being asleep or unconscious. Silence does not necessarily constitute consent, and past consent of sexual activities does not imply ongoing future consent. Whether the respondent has taken advantage of a position of influence over the complainant may be a factor in determining consent.

Definition: Physical harm or abuse, and threats of physical abuse, arising out of personal intimate relationship. This violence may also be called domestic abuse or spousal/partner abuse and may be subject to criminal prosecution under Minnesota state law.

Definition: Conduct directed at a specific person that is unwanted, unwelcome, or unreciprocated and that would cause a reasonable person to fear for her or his safety or the safety of others or to suffer substantial emotional distress.

Definition: Unlawful sexual acts where consent is not relevant, such as sexual contact with an individual under the statutory age of consent, as defined by Minnesota law, or between persons who are related to each other within degrees wherein marriage is prohibited by law.

Other Information

Which other offices or agencies have already been informed of the incident?

Please provide any additional information that may be helpful.