Incident Confidential Reporting Form

Confidential Reporting Form

This is the Lakeland University CONFIDENTIAL reporting form. The information provided will be sent directly to Alex Liosatos, Director of Health and Counseling Center, and a campus advocate.

If you are a victim or know someone who is a victim of any of the following violations you may submit a report by using the form below:

  • Sexual Assault
  • Dating Violence
  • Domestic Abuse
  • Stalking
  • Harassment
  • Discrimination
  • Other

If you or someone you know may be in danger or a threat to themselves, please immediately call 911 and/or campus security 920-565-1126.

If you would like to confidentially report and incident, please fill out the form and someone will be in contact with you.

Our site uses cookies and third-party analytics tools. Your continued use of this site indicates your consent to these services. See our privacy policy for more details. Dismiss this notice