Sexual Assault Anonymous Report

Need help urgently from a police officer?

Call 716-645-2222

This form is for anonymously reporting a sexual assault to University Police. Data compiled from this form assists with the compilation of statistical records for assaults that occur on the campus, in compliance with the Federal Student Right to Know and Campus Security Act. Filing this form will not result in an investigation.


  1. Complete the online form below. A person who has been assaulted may fill out this form himself or herself and send it to University Police or may ask a third party (such as a friend or a counselor) to do so.
  2. Submit the form by clicking Submit Form button at the end.

All information will be kept confidential. Your anonymous report of a sexual assault will be received by the New York State University Police. This report will not result in an investigation. If the victim changes their mind and needs to file a report, they can do so at any time by calling 716-645-2222.

Any information you pass on helps the police to track patterns of crime and can help them gain a profile on an attacker that may assist other similar investigations.

Responsibility to Report

Campus personnel, other than those with significant counseling responsibility (such as licensed professionals or certified counselors), must file a report when informed by a student of a sexual assault, to maintain campus compliance with the Federal Crime Awareness Act.

  • At the close of this form you will have the opportunity to connect to the confidential on-campus Advocate from Crisis Services.  If you need immediate support you can contact Crisis Services 24-hour hotline at 716-834-3131 or UB’s Counseling Services at 716-645-2720, or after hours through University Police by calling 716-645-2222 and ask for counselor on call. 
  • Whether you decide to involve the police or not the same services are offered to you, which include confidential treatment, medical care, counseling, emergency contraception, testing. You can learn more about resources and options at and, please note that some, but not all, medical options are time sensitive.

Need Help Completing the Form?

Bissell Hall, North Campus

Phone: 716-645-2222


Form Facts

Form Type: HTML
Requirements: None
Updated: 10/2018
Owner: University Police

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