University of Wisconsin - Stevens Point Official Reporting Form

Background Information

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Your full name:

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Use your local address and phone number

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

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Specific location:

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What exact location did the incident take place

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list a Drivers License number in the block labeled SID if available.

Name or Organization

Select Role

ID Number

Phone number

Email address

Hall/Address

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language. This field is required.

Please provide any additional information relevant to this report.

Emergency Card (gold card) was provided by RHD to paramedics

Dean on Call was contacted

Residence Hall Director was contacted

Student was arrested

Student was transported

University Police or Stevens Point Police Department were called

You must make at least one selection.

Did the student indicate any threats of harm to self or others? If yes, please describe what was said that indicated potential harm to self or others, and be as specific as possible. If this is an emergency, please contact University Police at 715-346-3456 or dial 911.(Required)

Yes No Unknown

This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission