Student Complaint Form

Reporter Information

Your full name:

Student ID (991):

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

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If multiple incidents, select the date of first incident. Clarify mulitple dates in the narrative.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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Room Number, Office, Landmark

Involved Parties

Please provide as much information as possible regarding those involved. Alleged/respondent is the person you are filing the report against. Witness/Bystander is anyone whom you feel witnessed or has direct knowledge of the incident. If you are submitting the report on behalf of someone else, please list the individual whom you feel is the victim/complainant.

Name

Select Role

Phone number

Email address

Hall/Address

Narrative

Please provide in the space below a detailed account of what occurred. You are encouraged to also write the narrative in a word document, and attached the document to the report through the "Supporting Documentation" section of this form.(Required) 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

Reporter Information

Involved Parties

Narrative

Supporting Documentation

Submission