Witness Statement Form

Background Information

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Your full name:

Who asked you to be a witness:

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:

Witness Information

Name or Organization

Select Gender

Select Role

ID Number

Phone number

Email address

Hall/Address

Your Statement

West Chester University expects that all the information you present will be true, complete, and correct. If you intentionally provide false or misleading information to the investigator or the hearing panel in this case, you will be in violation of the University's Code of Conduct, and you will be subject to disciplinary action for providing false information.

The referred student or organization will receive a copy of this statement prior to any hearing or resolution of a disciplinary case. The Hearing Officer, a University Hearing Panel, and members of the Office of Student Conduct may have access to this statement as part of a judicial case. You may be contacted to meet with a member of the staff and you may be called as a witness at a hearing.

If you are being referred of violating the code of conduct you are not required to provide a written statement.

* Please provide a detailed description of the incident that explains what you saw, heard, and experienced directly.(Required) This field is required.

Is there other information (e.g., a background story that explains the context, information you have come to learn since this incident, etc.) that you would like to provide? This field is required.

What is your relationship to the people involved in this situation (e.g., friend of the referred, roommate of the victim, do not know any of the people involved personally, etc.)?(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.

Background Information

Witness Information

Your Statement

Supporting Documentation

Submission