Iowa Lakes Community College Hazing Reporting

Iowa Lakes Community College Hazing Reporting

This form is intended for use by individuals associated with Iowa Lakes Community College
Please utilize this form to notify the authorities regarding a hazing incident. The individual completing the report may opt to maintain anonymity, furnish contact details for specific circumstances only, or express a preference to speak with an investigator. Reports may be submitted by individuals other than the victim.
Name (Optional)

First NameLast Name
Incident Information
Tell us what you are able to about the hazing incident. Providing detailed information can help officials identify individuals involved:
Tell us what you are able to about where the hazing incident occurred:
Tell us what you are able to about the suspect(s):
If suspect name is unknown, include information about gender, height, weight, race, facial description, hair description, and any other information that may aid law enforcement with an identification:
What other information do you want us to know?
Alcohol was voluntarily consumed by victimAlcohol was voluntarily consumed by suspect(s)Victim does not remember what happened (alcohol intoxication)Victim does not remember what happened (unknown reason)Victim suspects a drug was unknowingly given to themVictim voluntarily consumed illegal drugsSuspect(s) voluntarily consumed illegal drugsIncident occurred in a college dormitoryIncident occurred on Iowa Lakes campusIncident occurred within an athletic teamIncident occurred within a college clubThe victim was forced to participate in physical activityThe victim was forced to consume food, liquor, drugs, or substancesThe victim was subjected to humiliation/degradation (required to wear unusual or uncomfortable clothing, perform public stunts, or engage in morally questionable activities)The victim was forced to participate in acts of servitude (required to perform personal errands, chores, or other acts for existing members)The victim was subjected to kidnapping/forced confinement (transporting a person against their will or leaving them stranded)The victim was subjected to a sexual assault (engaged in sexual acts/rituals as part of an initiation process)The victim was forced to violate laws or moral/religious beliefs (activities that are illegal, morally offensive, or violate an individual's religious beliefs)The victim was subjected to physical harm (whipping, paddling, beating, branding, exposure to extreme weather, or any activity that could endanger physical health)The victim was subjected to psychological abuse (Verbal abuse, berating, humiliating activities, lineups for the purpose of interrogation or demeaning, or intentionally creating a sense of shame or embarrassment)The victim was subjected to excessive fatigue (sleep deprivation, excessive physical activity, or being forced to work or engage in activities that interfere with academic or other important responsibilities)Victim is a femaleVictim is a maleSuspect(s) is/are a femaleSuspect(s) is/are a maleSuspect(s) have other victimsThere are witnesses to the incidentI am the victim of the hazing incident being reportedI am a friend/relative of the victim of the hazing incident being reported
Advocate Information: Please answer the following to assist the Victim Advocates to better serve you and other victims.
YesNo
What is keeping you from reporting to Law Enforcement?
DepressionWithdrawal from friends and familyAnxietyAngerConfusionOther
Victim Advocates work closely with law enforcement to provide mental and emotional support to victims of hazing incidents. Advocates are also available to help address safety concerns that victim’s may have, such as safety planning, restraining orders, and Victim’s Compensation, if applicable. Contact with Victim Advocates is free and confidential.
YesNo
I want to speak with an investigator about my report.I am including my contact information but only want to be contacted if it is believed my information could assist in another investigationI do not want to be contacted by law enforcement
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
It is the policy of Iowa Lakes Community College not to discriminate in its programs, activities, or employment on the basis of race, color, national origin, sex, disability, age, sexual orientation, creed, religion, and actual or potential family, parental or marital status. If you have questions or complaints related to compliance with this policy, please contact a title IX coordinator for Iowa Lakes Community College, Administration Building, 19 South Seventh Street, Estherville, IA 51334, telephone: 712-362-0430, equity@iowalakes.edu or Director of the Office for Civil Rights, U.S. Department of Education, Cesar E. Chavez Memorial Building, 1244 Speer Boulevard, Suite 310, Denver, CO 80204-3582, Telephone: (303) 844-5695 FAX: (303) 844-4303, TDD 800-877-8339 Email: OCR.Denver@ed.gov.
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Iowa Lakes Community College Hazing Reporting

Incident Information