Incident Reporting Form

Background Information

Note: We do not accept anonymous reports. The full contents of this report will be shared with the student(s) against whom these allegations are made, including the name of the person reporting, the text of the report itself, and any attachments or additional evidence.

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Preferred First and Last Name:

Your Position/Title:

Your Phone Number:

Your Email Address:

Email address must be of a valid format.

Your Physical Address:

Urgency of this Report(Required):

This field is required.

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 involved (excluding yourself), including as many of the listed fields as you can provide.

Name or Organization

Select Role

Student ID Number

DOB (YYYY-MM-DD)

Phone number

Email Address

Local Address

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how). This field is required.

Were the UVM Police involved?(Required) This field is required.

If UVM Police were involved, please list the officer's name(s) if known. This field is required.

Supporting Documentation

Please note: Any submitted evidence, including this incident report and any attachments, will be shared directly with the student(s) you are reporting. If there is any information you do not want shared, please be sure to remove or redact it before submitting this report. 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