Incident Report Form

Reporter Background Information

Reporters are encouraged to provide as much or as little of their information to assist the University with appropriate follow-up to a report. Information submitted in this report will be used by the University for possible action in accordance with the Code of Student Conduct or the University's Title IX policy.

Reporters wishing to make an "anonymous" report may do so by writing "anonymous" in the name field. While anonymous reports will be evaluated in the same manner as "named" reports, the University may be hindered in its ability to follow-up.

Your full name:

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Or, you may write Anonymous

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Is report for criminal offense(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

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Options include Res Halls, Main Campus Location, Regional Campus Locations

Specific location:

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(i.e. room # or location description)

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled SID (Student ID #) if available

Name or Organization

Gender

Person Role

ID Number

Phone number

Description / Narrative

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how). To assist with clarity, we highly encourage that reporters write the report in third person (i.e. Joe Smith vs "I").

Description(Required) This field is required.

Please check all apply:

Campus Safety Responded

Paramedics Responded

Fire Department Responded

Police Department Responded

Person(s) Transported to Hospital

Person(s) Taken into Custody

You must make at least one selection.

Name Person(s) Transported/Taken to Hospital: This field is required.

Name of Hospital: This field is required.

Name Person(s) Taken into Custody: This field is required.

Responding Police Department, Name of Officer & Case Number: 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

Reporter Background Information

Involved Parties

Description / Narrative

Supporting Documentation

Submission