Okay, so I hope you are not offended but I took the time to draft up a template that might work. If it is of no use to you that is all right. Perhaps others might have their own ideas on how to tweek your statement.

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Attention: XXXXXXXXXXXXX
Re: THE MATTER OF XXXXXXXXXXX
Reference(s):[list here any coversations you had regarding the event]

Please accept this correspondence as testimony regarding the subject matter having occured on or about [time] at [location] on [date]. I make this statement to the best of my recollection.

Witnesses to the event is/are ____________________ of [location]. Contact is/are _______________.

On the evening of __________________ I proceeded to _______________ for the purposes of socializing with the witness. The bar is located at ______________________ .

At _________ I was approached by [name]. As my coach of three months, we were previously acquainted. While he appeared to not be consuming alcohol it should be noted I myself had consumed three. This by no means was over an acceptable limit. We exchanged small talk. He seemed to be strongly encouraging me to continue to consume additional alcohol of which I was concerned about.

At this time I became both uncomfortable and alarmed; and as such, commenced contacting my friend, [full name and contact]. The direction [name] was taking the conversation was outside my comfort zone. The subject of the text conversation was a plea for help. It was hoped that she could provide a distraction. She was unable to do so.

The context of the situation deteriorated to that which was more than merely uncomfortable. At this point he began to make unsolicited contact and got well inside my comfort zone. On no less than FIVE occasions I asked him to stop. There was no question about my intent. The physicalilty of the situation extended to attempts to kiss me. This constitutes a sexual assault.

When my attempts to rebuff his advances failed, I had no choice but to draw upon my martial arts skills to prevent further assault.

It was at this point that others in the establishment took notice.

From this point the evening progressed as........
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Sign and date this

In addition put into writing the action you wish to be taken. I hope this is of some help for you. I am quite upset that this happened to you. It is shocking. I am glad you were able to ultimately protect yourself.