Code of Student Conduct Incident Referral Form

Your Information

Please complete the fields below so that we may contact you in the event our office needs more information. An individual submitting a report may remain anonymous; however, anonymity may limit the the Office of Student Conduct's ability to investigate and respond to a complaint. We encourage you to at least provide an email account or phone number so that we may communicate with you if we need more information. Retaliation against anyone for reporting an alleged violation of this Code is strictly prohibited and persons who retaliate will be considered for further disciplinary action.

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Your Full Name:

Your Position/Title:

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(student, faculty, staff, etc.)

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:

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(address, room number, stairwell, etc.)

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. This includes the person(s) alleged to have committed the violation as well as any witnesses who will be able to corroborate information.

Name of Student or Organization

Select Role

UID Number

DOB if known (YYYY-MM-DD)

Phone number

Email address

Address

Incident Description

Please provide a detailed description of the incident exactly as it occurred using specific concise, objective language. Include all factual information that may be relevant.(Required) This field is required.

Supporting documentation is extremely helpful to support any allegations of misconduct (screenshots, videos, emails, etc.) I have supporting documentation that I have attached/uploaded to this form.(Required)

Yes No

This field is required.

I understand that I may be contacted by the Office of Student Conduct if they need more information.(Required)

Yes No

This field is required.

I understand that the information in this referral and the entire case file may be obtained by the referred student(s) (with the exception of personal contact information such as phone numbers or email addresses).(Required)

Yes No

This field is required.

Supporting Documentation and Evidence

Please attach any relevant, supporting documentation (i.e. screenshots, emails, photographs, etc.). Documentation should be clearly labeled with name of complaining party and date of submission. PDF, PNG, JPEG, etc. are preferred (HEIC cannot be viewed). 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Your Information

Involved Parties

Incident Description

Supporting Documentation and Evidence

Submission