Student Conduct Violation

Background Information

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

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Urgency of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. The most critical fields are the student ID Number and Student's name. If a student ID is not known, please fill in "99999999" - DO NOT LEAVE THE "STUDENT ID" BLANK.

(For non-students, please list an SSN or Drivers License number in the block labeled Student ID if available.)

Name or Organization

Select Gender

Select Role

ID Number

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.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission