Student Affairs Incident Reporting Form

Your position/title:

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.

Location of incident(Required):

This field is required.

Specific location:

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(e.g., a room or office number, parking lot)

List the individuals involved (excluding yourself). Complete the fields for which you know the information. For non-students, provide a Driver's License number in the block labeled SID.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Residence Hall or Physical Address

POSSESSION OF HARMFUL OR DANGEROUS ITEMS

Firearms (e.g., any gun, rifle, or pistol)

Knives, including assisted or spring opening knives, pocket/folding knives with a blade greater than three inches and an overall length of six inches when open, or throwing stars/knives

Other weapons (e.g., bows/arrows, swords, spears, bb guns, airsoft guns, or nunchucks)

Explosives, including dynamite cartridge, bomb, grenade, mine, or other powerful explosives

Fireworks

Dangerous chemicals or biological agents (e.g., any nuclear, biological, or chemical weapon of mass destruction)

You must make at least one selection.

FIRE SAFETY

Failure to properly evacuate during a fire alarm

Intentional sounding of a fire alarm without cause

Improper use of fire prevention equipment

Unauthorized setting of fires on University premises

You must make at least one selection.

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

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.

If other departments or individuals should receive a copy of this report, please select them below:

Director of Student Conduct, Laura Carper

Area Director for Founders Hall & The Woods, Grace Bergt

Area Director for Governors Hall & the Village, Christine Garst

Area Director for Mills Hall, Resharia Keller

Area Director for Ponder Hall & The Ridges, Christopher Hanhan

Graduate Community Director for The Ridges, Kerstan Nealy

Graduate Community Director for Founders Hall, Xelena Santiago

Associate Director, Residence Life, Dylan Lawing

Assistant VC for Student Affairs, Vollie Barnwell

Title IX Coordinator, Heather Lindkvist

Dean of Students, Megan Pugh

Associate Dean of Students, Laura Carper

Student Affairs Case Manager, Izzy Lott

University Police, Police Group

Email me a copy of this report

Student Affairs Incident Reporting Form

Background Information

Involved Parties

Incident Type

Supporting Documentation

Select copy recipients

Submission