Student Organization Self-Report Form

Background Information

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Your full name:

Student Organization:

Your phone number:

Your email address:

Email address must be of a valid format.

Position in Organization:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Provide information about any specific students or other parties involved in the incident.

Name

Questions

Please answer the questions below about the incident that occurred and how the organization responded to correct the behavior.

Describe the incident or behavior of concern that occurred related to the student organization.(Required) This field is required.

When did the officers or advisors of your organization become aware of the incident? How did you become aware?(Required) This field is required.

How has the organization addressed the behavior? Specifically, how and when was it addressed? What actions were taken?(Required) This field is required.

Were specific members identified as being responsible? Did the organization take action or are they taking action against those members? Does the organization want to refer those individuals to the Office of Student Conduct for possible violations?(Required) This field is required.

Any other information to share related to the incident and organization response?(Required) This field is required.

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