UTSA VSA Safety Concern Report
At UTSA VSA, the safety of our members, associates and those affiliated is our top priority. We strive to create a comfortable environment for students to fully express themselves. This form is meant for any situations that concerns your comfort or safety in the organization.

Please note:
- We are on your side; we're here ready to help and take actions quickly
- The report can be anonymous but it would help us assess the situation quickly if we know who to contact
- Everything that you write here is confidential to officers' eyes only and no one else, so feel free to be completely honest. Plus, the more we know, the more we can help.
- Our board advise that in addition to reporting, please consider reaching out to school services for extra help (attend counseling, or file a police report, etc.)

Kind Regards,
UTSA VSA Officer Board
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Name of Individual Reporting (Optional)
Name of Alleged Perpetrator *
Reason(s) For Filing Report *
Required
Date of Case (Estimate if necessary) *
MM
/
DD
/
YYYY
Account of Case *
How Can We Help?
Notes/Last Minute Thoughts
Submit
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