Preventing Sexual Violence in Higher Education Act Annual Report Template
Instructions
As a higher education institution in Illinois, your school must provide an annual report with data
and information related to the implementation of the Preventing Sexual Violence in Higher
Education Act (Act). Your report is due to the Illinois Department of Human Rights and the Illinois
Attorney General’s Office by November 1
st
of each year. See 110 ILCS 205/9.21(b). The annual
report covers data and information concerning the preceding calendar year (e.g. the 2020 annual
report covers data from January 1 – December 31, 2019).
This form provides guidance for reporting to the Illinois Attorney General’s Office. Schools may, but
are not required to, use this form for their report. A complete report must include the documents
identified in Part A and the data requested in Part B. Part C provides space, if desired, for your school
to include information to explain, contextualize or clarify data or information provided in Parts A and
B. Your school may submit its Annual Security & Fire Safety Report (i.e., Clery Act Report) and, if
necessary, supplement it with additional data and information to fulfill the Preventing Sexual
Violence in Higher Education Act’s reporting requirements.
If your institution fails to submit a report, or submits an incomplete report, it will be listed on the
Illinois Attorney General’s website as an institution that is not in compliance with the Act.
For more information regarding the reporting requirements, please read the Frequently Asked
Questions Regarding the Act’s Reporting Requirements, which you can find on the Illinois
Attorney General’s website at http://www.illinoisattorneygeneral.gov/rights/civilrights.html.
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As of 09/13/2022
Preventing Sexual Violence in Higher Education Act Annual Report
Form
Name of Higher Education Institution: ____________________________________________
Campus (if applicable): ________________________________________________________
Completed By/Primary Contact: _________________________________________________
Address: _________________________________________________________________
Phone Number: Email Address:
PART A
Provide one copy of the most recent version of each of the following documents:
The higher education institution’s comprehensive policy (see 110 ILCS 155/10); and
The higher education institution’s concise, written notification of a survivor’s rights and
options under its comprehensive policy (see 110 ILCS 155/15).
PART B
I. Campus Training, Education and Awareness
A. Student Primary Prevention Programming
Identify any and all institutional actions and strategies intended to prevent sexual violence
before it occurs by means of changing social norms and other approaches, including, without
limitation, training programs, poster and flyer campaigns, electronic communications, films,
guest speakers, symposia, conferences, seminars or panel discussions that occurred during the
preceding calendar year. See 110 ILCS 155/30(b). If necessary, append additional pages.
Program
name
Type/description Date(s) Location(s)
Target
audience
Number of
attendees
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B. Employee Training (optional)
Identify any and all training provided to higher education institution employees who, with respect
to reports of sexual violence, domestic violence, dating violence or stalking: (1) receive student
reports, (2) refer or provide services to survivors or (3) participate in the complaint resolution
procedure. See 110 ILCS 155/30(c). If necessary, append additional pages.
Program
name
Type/description Date(s) Location(s)
Target
audience
Number of
attendees
II. Reports
Identify the total number of reports made to the following groups of individuals in the preceding
calendar year. If a higher education institution is aware that a student reported an incident more
than once, it may provide an explanation for this or any other additional information regarding its
reports in Part C below. See 110 ILCS 155/25 and 110 ILCS 205/9.21(b).
Reports to the Title IX
coordinator/responsible
employees
Reports to confidential and
anonymous resources
Sexual violence
Domestic violence
Dating violence
Stalking
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A. Responses to Reports to the Title IX Coordinator or Responsible Employees
Of the total number of reports or disclosures made to the Title IX coordinator or responsible
employees at the higher education institution (identified in Part B, Section II), please report the
number of times the following occurred:
Survivor
requested not
to proceed
with the
complaint
resolution
procedure
HEI
investigated
allegation
HEI referred
allegation to
local or State
law
enforcement
HEI resolved
allegation
through
complaint
resolution
procedure
Sexual violence
Domestic violence
Dating violence
Stalking
B. Complaint Resolution Procedure Outcomes
Of the total number of reports reviewed through the complaint resolution procedure, identify
the number of students who received the following outcomes. Please provide a description of
the other types of discipline students received for violating the comprehensive policy in Part C
of this report.
Found not
responsible for
violation of
comprehensive
policy
Dismissed/
expelled
Suspended
Otherwise
disciplined
Sexual violence
Domestic violence
Dating violence
Stalking
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PART C
Use this space to provide any explanations or clarifications for information and data provided as
part of the report. (Append additional pages as necessary.)
Submit completed reports via mail or email to the addresses below by November 1
st
:
• Office of the Illinois Attorney General
Civil Rights Bureau
100 W. Randolph Street, 11th Floor
Chicago, IL 60601
• Illinois Department of Human Rights
555 W. Monroe Street, Suite 700
Chicago, IL 60661
IDHR.LiaisonUnit@illinois.gov
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