Welcome to the secure Sexual Violence Disclosure Form.

This form may be used for any of the following:

  • Report an incident of sexual violence that you experienced
  • Report a disclosure of sexual violence that you received
  • Report an incident of sexual violence that you witnessed

Information provided on this form will be submitted to the Vice-Principal, Students for incidents involving students, and will be forwarded to the Director, Human Resource when an incident involves a faculty/staff member. If you prefer not to use the online form, you may contact either the Vice-Principal, Students or the Director, Human Resources directly.

PLEASE NOTE: Completion of all questions is not required, except for those with a red* beside them, as Brescia must report the information to the Ministry of Advanced Education and Skills Development.

Disclosure Form
Survivor refers to the individual who experienced the incident of sexual violence that is being disclosed in this form.
Other individuals may include: additional survivors, additional Person(s) Accused/Respondent(s), potential witnesses, etc. If known, please provide any contact and/or descriptive information (e.g. first name, last name, student ID number, date of birth, email address, phone number etc.) to help with identification.
Include am or pm
Drop a file here or click to upload Choose File
Maximum upload size: 2.1MB
This could include copies of emails, text messages, social media posts, etc.