Date of Assault Time

Place of Occurrence
(An address is preferred, but if it occurred at the victim's home, a team area, part of town or street coordinates are acceptable.)

Name/Nickname Address
Age
Physical Description/Distinguishing Characteristics
(Include Odors, Scars, Tattoos, Facial Hair, Speech Impediments, Etc.)

Suspect/Victim Relationship Partner/Lover Ex-Partner/Lover Spouse Colleague/Co-Worker Acquaintance Met Same Day-Socially Met Same Day-NonSocially Stranger

Type of Coercion/Force Verbal Physical Threat of Death Presence of a Weapon Yes No If Yes, what type Incapacitation by Drugs or Alcohol Yes No If Yes, what type Other Coercion/Force

Were You physically injured?
Yes No
If Yes, please describe the extent and nature of your injuries in detail

Nature of the Assault Attempted Completed Vaginal Oral Anal

Place of Occurrence Victim's Home Suspect's Home Unknown Home Hike/Bike Trail Car/Vehicle Workplace Park Outdoors Parking Lot Other

Manner of initial contact (I.E.: Came to victim's door, attacked on street, etc.)

What did the suspect say before, during and after the assault?(Please be as specific as possible)

Do you plan to make a formal report to the police?
Yes No
Not Sure

If not yes, why have you chosen to make an anonymous report rather that make a formal report to the police?

Please give a narrative of the sexual assault(Please provide as much detailed information as possible)

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Lincoln Police Department
Crime Analysis Unit
575 South 10th Street
Lincoln, Nebraska 68508

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