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Incident Reporting Form

If you need to report an emergency, call University Police at 561-297-3500, or dial 911.

The Dean of Students office within the Division of Student Affairs at Florida Atlantic University appreciates your awareness in supporting the well-being of our students and your assistance in reporting incidents to allow us to uphold the Student Code of Conduct. If you have concerns for a student’s welfare or have knowledge of an FAU student violating the Student Code of Conduct, you are encouraged to notify our office by submitting a report or, if urgent, directly contacting our office for immediate response during business hours at 561-297-3542.

Reportable behaviors may include but not be limited to, Student Code of Conduct violations, a student who you feel may be struggling physically or psychologically, academic concerns, or any other behaviors of concern that you would like to see addressed or would like to discuss. When completing this form, please include your name, title, and contact information. Please note that students and community members may submit anonymous reports. However, this may limit the ability to address the concerning behavior(s). Faculty and staff MUST include their contact information.

Furthermore, please be aware that the individuals involved may be afforded certain privacy rights under the Family Educational Rights and Privacy Act (FERPA). The Dean of Students strives to maintain information provided as private, to the extent in which the law allows. Please note that students have the right to inspect any information submitted regarding this matter. Our office may disclose information to appropriate university staff for evaluation and/or response purposes.

If you have any questions or concerns, please call the Dean of Students office at 561-297-3542.

Background Information

Your full name:

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.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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 Driver's License number in the block labeled "ID Number" if available.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

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.