Sexual Violence Anonymous Reporting Form

This form should be used by members of the Fairfield University community who have experienced or have been witness to sexual violence.
The information will be used to identify and address troubling trends.

Please print the form, complete it, and submit to the Department of Public Safety, Loyola Hall, room 2.

Confidential Reporting Form

If you know of a crime that has occurred on campus we would like you to report it.

This system is monitored Monday through Friday from 8:30 a.m. to 4:30 p.m.

For immediate service, call (203) 254-4090 or ext. 4090 - all phone calls can remain anonymous.

All information is kept confidential unless you indicate otherwise.

Fields marked with an asterisk (*) must be completed.

* Describe the nature of the crime:

* Where did the crime occur:

Enter the dates and times associated with this crime:

* Dates:


* Times:

Suspect's Name(s):

If unknown, provide a detailed description:

Would you like us to contact you? If so, please provide your necessary contact information:

Contact info:

Your Name: