Hazing Incident Reporting Form

Background Information

Though not required, we ask that you please provide your name and contact information. Your identity will be held in confidence. It will not be disclosed to the individuals or organization in question. Please report the acts of hazing even if you choose to omit your name and contact information. Please include as much detail as possible and supporting documentation (i.e., times, dates, locations, individuals present, screen shots of communication, etc.)

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

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Please provide a detailed description of the incident(s) and/or concern(s):

Specific location:

Involved Parties

Please list the individuals or organization involved (excluding yourself).

Name or organization

Select Role

Student ID number

Questions

Please note that if you do not know or choose not to provide the name of the organization that you are reporting, the University may be limited in its ability to address the allegations.

What is the name of the organization that you are reporting? This field is required.

Please provide a detailed description of the incident/concern using specific concise, objective language.(Required) This field is required.

How did you become aware of the act(s) and/or event(s)?(Required) This field is required.

Are there other individuals who could corroborate the information that you are providing? If so, please provide their names and contact information, if available. This field is required.

Supporting Documentation

Photos, video, email, screen shots 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.

Background Information

Involved Parties

Questions

Supporting Documentation

Submission