Sexual Misconduct Reporting Form

IF THIS IS AN EMERGENCY, PLEASE CALL 911 or UH Police AT 713-743-3333. THIS FORM MUST NOT TO BE USED TO REPORT INCIDENTS THAT REQUIRE AN IMMEDIATE EMERGENCY RESPONSE.

When should you complete this form?

  • Use this form to report attempted or completed incidents of sexual assault, sexual harassment, stalking, dating violence, domestic violence, or sexual exploitation.

What if you are unsure if this situation falls into one of those categories?

  • Complete this form to the best of your ability and the Title IX coordinator or designee will determine how the information will be handled.

Can you make an anonymous report?

  • Yes you may provide information anonymously through this form by leaving your contact information blank.
  • Or you can report anonymously through UH's Fraud & Non Compliance Hotline.
  • Please understand, that anonymous reports limit the university's ability to respond and sharing your identity may be helpful to connect you with resources, like medical and counseling services, and provide information about your options for further action.

What if I am a Responsible Employee reporting an incident I have learned about that involves another person?

  • If you are reporting as part of your requirement as a responsible employee under Title IX, you can identify your role in STEP 3 of using this form.

The information provided in this report can be used by the university to conduct an investigation or take actions to stop the behavior and prevent its recurrence. If you have other questions contact the Title IX coordinator by email or by phone 713-­743-­8835.

Step 1: Information on person submitting this form

Step 2: Involved Parties

Step 3: Questions

Are you reporting as a Responsible Employee?

Action Requested: By completing and submitting this form I am requesting the following:



Have you filed a criminal report with the campus police?
Would you like to file a criminal report with campus police?

Step 4: Supporting Documentation/Attachements

Photos, video, email and other supporting documents may by attached below. Each file can not be larger than 15 mb.

Select files...


Step 5: Final review