Non-Confidential Incident Reporting Form

Non-Confidential Reporting Form


This is the Lakeland University Non-Confidential reporting form. When this form is submitted, the University will respond in accordance with its policies and procedures. The information provided will be sent directly to David Simon, Title IX Coordinator.

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.


Lakeland University's primary concern is the safety of its students, faculty, and staff, and to encourage reporting of Prohibited Conduct. All University employees who are deemed responsible employees have a duty to report actual or suspected Prohibited Conduct to appropriate officials, though there are some limited exceptions for those identified in the policy as a Confidential Resource. Reporting Parties may want to consider carefully whether they share personally identifiable details with employees who have a duty to report, as those details must be shared by the employee with the Title IX Coordinator and/or Deputy Title IX Coordinator(s), and/or Lakeland University Campus Safety Department. To be clear, employees with a duty to report must share all details of the reports they receive, including personally identifiable information.

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

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