Student Development and Wellbeing

Before completing this form, please read the guidance notes about the form and what will happen after you submit your report.
Guidance Notes

I have read the guidance notes

Your reporting options

Please select one option

I would like to report an incident(s) and request that the University take formal action

I would like to make a report anonymously

Please be advised that where the University identifies any potential risk to other members of the university community in relation to your report, they may engage in follow-up action under their legal duty of care to minimise any risk to others.

Would you like to access any help and support from the University in relation to the incident?
(If you are making an anonymous report, please contact Student Development and Well-being directly on 0151 291 3427 or email sdw@hope.ac.uk to access immediate help and support.)

Yes

No

Your Contact Information

Details in this section may be left blank if you are making an anonymous report.

Name

Student ID No.

Email Address

Contact Phone No.

Gender

Details of the person(s) you are reporting, and their department if known

Name

Gender

What is their relationship to you? (E.g. friend, partner, lecturer, stranger, etc.)

Details of the incident

Please be aware that, with your consent, the information you provide relating to the incident will be shared with the person(s) you have reported when informing them of the allegations. Include as much or as little detail as you wish, there will be other opportunities for you to provide further information.

Date, time, and Location of Incident – if reporting multiple incidents please provide all dates, times, and locations.

Please provide details of the incident (there will be a further opportunity for you to provide more information).

Please provide the details of any witnesses to the incident (if any).
(e.g. name, relationship to you, are they a student at Hope?)

Have you notified the police?

Yes

No

I don’t want to notify the Police at this stage

Supporting Documentation

You can upload supporting documentation below.

(e.g. photos, videos, e-mails, text messages, chat logs, screenshots. Maximum file size: 40mb)

Add a file...

Outcome

What actions would you like to happen regarding this report process?
(E.g. change of university halls accommodation, referral to specialist support external to the University, a disciplinary response, etc.)

The University can put in place precautionary measures whilst an investigation is ongoing to prevent contact between you and the person you are reporting. Would you like this to happen?

Yes

No

Consent

In order to process the information provided in this form and to respond appropriately where necessary, your consent is required.

I consent to the information I have submitted in this form being processed, stored and confidentially shared by the University for the purposes of investigating the reported incident and/or to provide me with appropriate advice and support, where I have requested this.

Yes

No

I understand that details of the incident provided in this form, including any relevant supporting documentation, may be shared with the person(s) identified within this form who I am reporting.
I also understand that the University may confidentially share information regarding the incident to third parties (e.g. Police) where required to do so. *(You will always be made aware and your consent sought where there is a need to share personal or sensitive information relating to this report).

I agree to the above statement