Student Code of Conduct Report Form

Background Information (Required)

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Your position/title (Required):

Your phone number (Required):

Your email address (Required):

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Your office location/address:

Nature of report (Required)(Required):

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Urgency of this report(Required):

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Date of incident (Required)(Required):

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Time of incident (Required):

Location of incident(Required):

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Specific location (Required):

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Room number, course number and section. (if applicable)

Involved Parties (Required)

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

Name or Organization

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Student ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Address (if applicable)

Critical Information Needed (Required)

Supporting Documentation (Required)

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
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Email me a copy of this report

Background Information (Required)

Involved Parties (Required)

Critical Information Needed (Required)

Supporting Documentation (Required)

Submission