throughout the campus, and including information as part of programs to educate students on sexual assault prevention and awareness. 164. Form to distribute to victims of sexual assault (a) Requirement To develop and distribute form Each institution of higher education that is subject to this part shall develop a one-page form containing information to provide guidance and assistance to students who may be victims of sexual assault, and shall make the form widely available to students. (b) Contents of form The form developed under this section shall contain such information as the institution considers appropriate, and may include the following: (1) Information about the services of counselors which are available pursuant to section 163, including a statement that the counselor will provide the maximum degree of confidentiality permitted under law, and a brief description of the circumstances under which the counselor may be required to report information notwithstanding the victim’s desire to keep the information confidential. (2) Information about other appropriate campus resources and resources in the local community, including contact information. (3) Information about where to obtain medical treatment, and information about transportation services to such medical treatment facilities, if available. (4) Information about the importance of preserving evidence after a sexual assault. (5) Information about how to file a report with local law enforcement agencies. (6) Information about the victim’s right to request accommodations, and examples of accommodations that may be provided. (7) Information about the victim’s right to request that the institution begin an investigation of an allegation of sexual assault and initiate an institutional disciplinary proceeding if the alleged perpetrator of the assault is another student or a member of the faculty or staff of the institution. (8) A statement that an institutional disciplinary proceeding is not a substitute for a criminal justice proceeding. (9) Information