Residence Life Incident Report

This form should be used for reporting: Student Code of Conduct related incidents, Concerning Student Behavior, and Medical Incidents.

See the reports below for Sexual Misconduct & Relationship Violence (Title IX) related incidents and Hazing Incidents.

Sexual Misconduct and Relationship Violence Form
Hazing Report Form

Reporter Information

Your Full Name *

What is your title *

Your cell number *

Type of incident *

Student Code of Conduct - The student is in violation of one or more policies on campus. Medical - The student is sick or injured Behavioral Concern - The student is acting out of character in a way that is harming the community, themselves, or there is the possibility of harm.

Date of incident *

Location of incident *

Specific location *

Who was involved

Please include the students that were involved. Do not include staff members (including yourself or other RAs). Please include their names in the Incident Description.

Student Name *

ID Number *

Role *

Room Assignment *

Student #2 Full Name

Student #2 ID Number

Student #2 Role

Student #2 Room Assignment

Student #3 Full Name

Student #3 ID Number

Student #3 Role

Student #3 Room Number

Additional Students

If there are more than three students involved please list their first and last name, 700 number, and their role in the situation.

Questions

Description *

Please provide a detailed description of the incident/concern using specific concise, objective language. If you have listed an individual as an involved person, he or she should appear at least once in the narrative. For matters involving Conduct violations, please provide as much detail as possible in describing the behaviors and activities that occurred. The use of direct quotes, including any language used by any party involved, is encouraged. Avoid using pronouns when multiple individuals are involved. These reports are generally reviewed by the appropriate staff member in the Office of Residence Life and/or the Office of Student Development.

Who was the ResLife professional staff member on-call during this incident *

If you do not know who was on call select Res Life and the report will be submitted.

Was the ResLife professional staff member on-call notified of this incident? *

Did the ResLife professional staff member respond to this incident in person? *

For SAD (Suicide, Alcohol, Drugs) Coordinator must be present. For visitation or other minor incidents, the Coordinator does not have to be present.

Was the Office of Public Safety notified of this incident? *

For alcohol and drug incidents Security must be notified. For suicidal idieation call the Coordinator On-Call first and let them determine when Security needs to be called.

Did the Office of Public Safety respond to this incident in person? *

Is there any other information you would like to share about the incident?

Photos, video, email, and other supporting documents may be attached below

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