Confidential Hazing Report

Background Information

If you choose to provide your identity, it will be kept confidential. It will not be disclosed to the individuals or group in question. However, please be advised that an anonymous report may not provide sufficient information to initiate an investigation.

Our office will likely need to follow-up to gather additional details with you in order to initiate and investigation. All information obtained will be used solely for this purpose. If you would prefer to speak with someone about this form and disclosing your identity, please feel free to call the Dean of Students Office at 843-349-4161.

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Your full name:

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Providing this information allows us to follow up with you; it will NOT BE shared with others.

Your position/title/role:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

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 (Organizations, Individuals, etc.)

This section can include the name of any organization involved and/or individuals. Please include which organization(s) involved in the incident and any information that supports the conclusion of which organization is involved (i.e. colors, uniform, Greek letters, etc)

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Incident Information

When did the event(s) occur?(Required) This field is required.

Where did the event(s) take place?(Required) This field is required.

Who was involved in this event?(Required) This field is required.

Are there any other people that either were present or can corroborate the information you are providing? Please provide their names and contact information (if available).(Required) This field is required.

How did you become aware of the event(s)?(Required) This field is required.

Please describe the event(s) in as much detail as possible.(Required) This field is required.

National Hazing Prevention Anonymous Hotline Recognizing the negative impact hazing has on all of Greek life, 20 international fraternities and sororities have joined together to establish a national Anti-Hazing Hotline. The toll-free number, 1-888-NOT-HAZE is available to those who think they, or students they know, have been or may be victims of hazing. Callers may remain anonymous or provide personal information so that they may be responded to directly. The law firm of Manley Burke will forward copies of messages to the appropriate national organizations along with the relevant hazing laws for that jurisdiction. Coastal Carolina University students, faculty and staff may also use this resource but are encouraged to use local and campus resources if they suspect that hazing is occurring within the Greek system. Toll Free: 1-888-NOT-HAZE (1-888-668-4293)((Required)

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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 (Organizations, Individuals, etc.)

Incident Information

Supporting Documentation

Submission