ࡱ> nqm_ )fbjbj 8l5\5\  8tNB*f}.y){){){){){){)$+^.)]}}))oooFy)oy)oorM%TM&v^%e)*0B*%.{.M&.M&o))3<B*. > T:  Police Department Confidential Sexual Assault, Stalking, Domestic and Dating Violence Report Form This form is for the purpose of collecting data to determine the number of incidents occurring within this community in order to comply with federal law and to develop appropriate resources. INSTRUCTIONS This form is intended for the use in cases regarding rape/sexual assault, attempted rape/sexual assault, domestic/dating violence, or stalking. Do not complete this form in presence of assault survivor. Do not include the survivors name or other identifying information (e.g. student identification number, address, phone number) on this form. Record as much requested data as possible based on information volunteered or discussed. Do not pry for information, just list the information obtained in the conversation. Complete this form even if the survivor indicates that he or she has spoken with another person on campus and even if you will be referring the survivor to another department. Completed forms should be forwarded to Scott Forshee, Chief of University Police, 1500 University Drive, Billings, MT 59101. For immediate response (business and after hours), call (406) 657-2147. Reported to (optional)Date/Time reportedDate/Time incident occurred FORMTEXT        FORMTEXT       FORMTEXT      For classification purposes  Please classify the incident by using the below legal definitions. Sex OffensesRape Categories FORMDROPDOWN  FORMDROPDOWN  Dating Violence, Domestic Violence, or Stalking FORMDROPDOWN  General description of incident, (or attempted), including whether or not reported to anyone.  FORMTEXT      ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SURVIVOR INFORMATIONASSAILANT INFORMATIONMale  FORMCHECKBOX  Female  FORMCHECKBOX  Student  FORMCHECKBOX  Non-student  FORMCHECKBOX  Student Status  FORMDROPDOWN  Resident  FORMCHECKBOX  Commuter  FORMCHECKBOX  Male  FORMCHECKBOX  Female  FORMCHECKBOX  Stranger  FORMCHECKBOX  Acquaintance  FORMCHECKBOX  Student  FORMCHECKBOX  Non-student  FORMCHECKBOX  Resident  FORMCHECKBOX  Commuter  FORMCHECKBOX  # of Assailants  FORMTEXT   Location of Incident Hate Crime Related Yes  FORMCHECKBOX  No  FORMCHECKBOX    FORMTEXT       Check that which applies to where the incident occurredUniversity - owned, controlled, or leased property? Yes  FORMCHECKBOX  No  FORMCHECKBOX  University - sponsored activity or event? Yes  FORMCHECKBOX  No  FORMCHECKBOX  Was either of the persons under the influence of alcohol at the time of the incident? SURVIVOR  FORMCHECKBOX  ASSAILANT  FORMCHECKBOX  BOTH  FORMCHECKBOX  NEITHER  FORMCHECKBOX  DEFINITIONS FOR CLASSIFICATION PURPOSES: (Enter the correct classification of the incident you are reporting) Sex Offenses: Any sexual act directed against another person, forcibly and/or against that persons will: Or not forcibly against the persons will where the victim is incapable of giving consent. Forcible Fondling: The touching of the private body parts of another person for the purpose of sexual gratification, forcibly and/or against that persons will: Or, not forcibly or against the persons will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent or mental physical incapacity. Statutory Rape: Non-forcible sexual intercourse with a person who is under the statutory age of consent. Incest: Non-forcible sexual intercourse between persons who are related to each other within the degrees wherein mirage is prohibited by law. Rape: The carnal knowledge of a person, forcibly and/or against the persons will: Or not forcibly or against the persons will where the victim is incapable of giving consent because of his/her temporary permanent mental or physical incapacity(or because of his/her youth). Forcible Sodomy: Oral or anal sexual intercourse with another person, forcibly and/or against that persons will: Or not forcibly against the persons will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent mental or physical capacity. Sexual Assault with an Object: The use of an object or instrument to unlawfully penetrate, however slightly, the genital or anal opening of the body of another person, forcibly and/or against that persons will: Or not forcibly or against the persons will where the victim is incapable of giving consent because of his/her youth or because of his/her temporary or permanent or mental physical incapacity. Dating Violence: Violence committed by a person who is or has been in a social relationship of a romantic or intimate nature with the victim and, where the existence of such a relationship shall be determined by the victim with consideration of the following factors: the length of the relationship, the type of relationship, (3) the frequency of the interaction between the persons involved in the relationship. Domestic Violence: Includes felony or misdemeanor crimes of violence committed by a current or former spouse of the victim, by a person with whom the victim shares a child in common, by a person who is cohabitating with or has cohabitated with the victim as a spouse or intimate partner, by a person similarly situated to a spouse of the victim under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred, or by any other person against an adult or youth victim who is protected from that persons acts under the domestic or family violence laws of the jurisdiction in which the crime of violence occurred. Stalking: A course of conduct directed at a specific person that would cause a reasonable person to fear for her, his, or others' safety, or to suffer substantial emotional distress. Hate Crime: Defined as a criminal offense committed against a person or property which is motivated, in whole or in part, by the offenders bias. Bias is a preformed negative opinion or attitude toward a group of persons based on their race, gender, religion, national origin, sexual orientation, gender identity, ethnicity or disability. 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