Sexual Misconduct Form

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We recognize that discussing this topic might be difficult. Our goal with this questionnaire is to better understand your experience and ensure you receive the appropriate legal support and resources. Please answer only what you feel comfortable sharing. If any question is too challenging or doesn't apply, you can skip it.

Your comfort is our priority. Choose the options that are relevant to you and feel free to leave out any questions that don't resonate with your situation.

Your responses are completely confidential and will only be shared with our legal team for the purpose of evaluating your case. We are committed to protecting your privacy and supporting you throughout this process.

Name*

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Email*

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I Agree to the Privacy Policy, Terms of Use, and Legal Disclaimer*

Consent*

I consent to providing this information and understand it will be used to assess my legal options. I understand this is not legal advice and does not create an attorney-client relationship.

Please describe the type of unwanted experience you had:

Unwanted Physical Contact

Non-Physical Sexual Advances / Harassment

Workplace Specific Harassment

Institutional or Organizational Abuse

Sexual Coercion and Manipulation

Stalking and Invasion of Privacy

Online Harassment and Abuse

Historical or Ongoing Abuse

Other Forms of Abuse or Harassment

Did the unwanted physical contact involve sexual touching or groping, rape or attempted rape, forced kissing, or other forms of physical assault? Please list all that apply.

Did the non-physical sexual advances or harassment include unsolicited sexual propositions, inappropriate or suggestive comments, requests for sexual favors, unwanted sexual comments or jokes, or other forms of non-physical harassment? Please list all that apply.

What types of workplace-specific harassment did you experience? Examples include harassment by a colleague, supervisor, or client, unwelcome sexual behavior affecting the work environment, or retaliation for rejecting advances or reporting harassment. Please list all that apply.

What forms of institutional or organizational abuse did you experience? This might include abuse within institutions (schools, religious organizations, etc.), failure of the institution to protect or take action, or abuse of power by authority figures. Please list all that apply.

What types of sexual coercion or manipulation did you experience? This could involve pressure to engage in sexual acts, threats or blackmail related to sexual activity, or manipulation or deceit to obtain sexual consent. Please list all that apply.

What type of stalking or invasion of privacy did you experience? Did it involve unwanted communication (calls, texts, emails), sharing or threatening to share intimate photos or videos without consent, or being followed or spied upon? Please list all that apply.

What kind of online harassment or abuse did you experience? This might include cyberstalking, distribution of non-consensual pornography (revenge porn), unwanted sexual messages, or comments on social media. Please list all that apply.

Please describe the historical or ongoing abuse you have experienced. Did it involve past abuse that still affects you, or ongoing harassment or abuse? Please list all that apply.

Have you experienced any other forms of abuse or harassment that don’t fit into the above categories but are relevant to your situation? If so, please list or describe your experience.

When did this experience occur, or when was the most recent experience if ongoing? If you don't know the exact date, please select the approximate date and/or year.

MM slash DD slash YYYY

Please describe what happened, including any details you feel comfortable sharing about the unwanted advances or contact.

Do you know the name of the person(s) involved? If so, please provide their full name(s) or any information you know about them (e.g., address, phone number, email, place of work, etc.).

What is or was your relationship to this person or these people? (select all that apply)

Coworker /Supervisor

Client/Customer

Friend/Acquaintance/Neighbor/Tenant/Landlord

Teacher/Professor

Stranger

Other

Please provide the name of the company associated with the incident?

Please provide the name of the school associated with the incident?

Please provide any information you would like us to know?

Does or did this person represent any institution, organization, event, or company during your interactions with them?

Yes

Please provide the name or a brief description of the organization they are or were affiliated with.

Can you tell me if the person involved is connected to any well-known organizations or holds any prominent public roles?

Does the organization or individual involved have influence, or a strong presence, in your community or any specific industry? If so, please describe.

Where did this experience occur?

Work

Event

School/College

Public Place

Online/Virtual Space

Home

Other

Please provide the name of the company associated with the incident?

Please provide the name of the institution?

Please provide any information you would like us to know?

Please select all options that apply to how this experience has impacted you?

Physical injuries

Emotional distress (anxiety, depression, PTSD, etc.)

Financial difficulties (lost wages, medical bills, therapy costs, etc.)

Career setbacks (demotion, termination, retaliation, etc.)

Relationship problems

Other

Please provide any information you would like us to know?

Have you sought any medical treatment or counseling as a result of this experience? If yes, please provide details.

Have you shared any details of this experience with anyone (e.g., police, school, employer, HR, etc.)?

Yes

What was the outcome of sharing your experience?

Have you consulted with another lawyer about this matter, or do you currently have legal representation?

Yes

Is there anything else you'd like to share that you think could be helpful?

(e.g., Names of people who may have witnessed the incident, any evidence you have in your possession, like text messages, emails, voicemails, restraining orders, etc, and anything else you think would help us understand your experience)

Thank you for taking the time to share your experience with us. Your submission and responses are kept completely private & confidential and will only be used for purposes of evaluating your case. We are committed to protecting your privacy and rights as we support you through this process. A representative from our organization will be in touch soon or during your scheduled time. Thank you.

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