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USA Cycling SafeSport Online Reporting Form

Reporting Abuse

USA Cycling requires members to report sexual misconduct and other SafeSport violations. USA Cycling appreciates your willingness to report inappropriate behavior. By submitting this form, you are giving permission to USA Cycling's SafeSport Program staff to contact you.

Knowingly making a false or vindictive report will not be tolerated and is a direct violation of USA Cycling’s Safe Sport Program.

(*) Denotes Required Field

Person Being Reported

Name*

Age or Approximate age

Gender* Male
Female

City

State/Region

Club/Team/Affiliation

Position/Role* - Control-click (Command-click on Mac) to select multiple items.

Please type other position/role:

Alleged Offense

Classify the offense* (to the best of your ability) - Control-click (Command-click on Mac) to select multiple items.

Please type other offense:

Approximate Date(s) of Alleged Offense*

Location of alleged offense*

Description of alleged offense*

Knowledge of victim(s) involved in the alleged offense: I am aware of a victim(s) invlolved
I am not aware of any victim(s)

Victim(s)

If you are the victim please enter your information below.

Name

Age or approximate age

Gender Male
Female

Club/Team/Affiliation

Additional Information

Fill in this section if additional victims are involved:

Name

Age or approximate age

Gender Male
Female

Club/Team/Affiliation

Additional Information

Collateral Information

List anyone (other than those already listed) who may be able to provide additional information regarding the alleged offense. SafeSport staff will not identify you when we contact these individuals.

Name

Phone

Email

Club/Team/Affiliation

Gender Male
Female

Position/Role - Control-click (Command-click on Mac) to select multiple items.

Please type other position/role:

Name

Phone

Email

Club/Team/Affiliation

Gender Male
Female

Position/Role - Control-click (Command-click on Mac) to select multiple items.

Please type other position/role:

Reporter's Information

All reports are kept confidential by SafeSport Program staff. Any person alleging misconduct should not fear retribution and/or consequence when filing a report he/she believes is true. Retaliation of a report made in good faith is a violation of the USA Cycling SafeSport Policies.

Name

Phone

Email

USA Cycling Member: Yes
No
Unsure

Club/Team/Affiliation

Relationship to victim (select all that apply, if any): - Control-click (Command-click on Mac) to select multiple items.

Please type other relationship:

Enter any other information you feel would be helpful to an investigation of the alleged offense:

Some alleged offenses require law enforcement or child protection services to be notified. The alleged offense you reported may or may not meet this requirement.

Have you reported this allegation to law enforcement or child protection services?* Yes
No

If so, would you share the local or state entity in which you reported to?

Enter Code*: