Gender-Based Sexual Misconduct Referral Form

Gender-Based Sexual Misconduct Referral Form

Kishwaukee College strives to protect the reporter’s confidentiality, whenever possible. Additionally, a person can submit anonymously by omitting their name and contact information, however we will not be able to follow-up on this type of report. All reports are submitted to a licensed counselor at the college for review. Reports identified for investigation will be forwarded to the Dean of Student Services.

The Kishwaukee College Comprehensive Policy Relating To Gender-Based or Sexual Misconduct, Domestic/Dating Violence, Sexual Assault and Stalking can be found on the college website, in the student catalog and in the Dean of Student Services office.

If you want to consult with a confidential advisor prior to completing this report please contact:  Safe Passage at 815-756-5228



Involved Parties
Person 1
Person 2
Person 3
Files must be less than 2 MB.
Allowed file types: gif jpg jpeg png pdf doc docx ppt pptx xls xlsx.