Student Conduct Incident Reporting Form

Reporting Party Information

While anonymous reports are accepted, you are STRONGLY encouraged to provide your name and contact information in order to allow us to most effectively address the reported behavior.

Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

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 (excluding yourself) involved in the reported incident. For non-students, please list an SSN or Drivers License number in the block labeled ID Number, if available. For students, please list the ECSU ID Number (without dashes).

NOTE THAT INVOLVED PARTIES INCLUDE

ALLEGED = person accused of behavior that violates policy

VICTIM = person impacted by alleged behavior

WITNESS = person, excluding yourself, who observed the alleged behavior and can provide information

NON-ECSU STUDENT/OTHER

Name or Organization

Select Gender

Select Role

ECSU ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Additional Information

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size. Attachments require time to upload, so please be patient after submitting this form. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Reporting Party Information

Involved Parties

Additional Information

Supporting Documentation

Submission