Student

Incident Report Form

Information sent through this form will be processed by the Dean of Students Office. Incidents may be referred to Interfraternity Council Conduct Board, Panhellenic Conduct Board, or may be investigated by the Dean of Students. For additional information on the student conduct process, please click here.

Additional questions, or comments, should be directed to Assistant Dean of Students Arlyn Bradshaw.

ΑΧΩ   ΔΓ   ΧΩ   ΚΚΓ   ΠΒΦ   ΑΦ   ΚΣ   ΦΔΘ   ΠΚΑ   ΣΧ   ΣΝ   ΣΦΕ   ΒΘΠ   ΔΣΦ
      ΚΔΧ   ΔΣΘ   ΩΔΦ   ΑΚΑ   ΘΝΞ  
University of Utah Greek Council Incident Report
Date of Incident *

MM 		/
DD 		/
YYYY
HH 		:
MM
AM/PM
Location of Incident
Specific Location *
Authorities Involved *
 Salt Lake City Police 
 University of Utah Police 
 University of Utah Security 
 No Authorities Involved 
Police Case Number
Name of Incident Participant

First
Last
Name of Incident Participant

First
Last
Name of Incident Participant

First
Last
Name of Incident Witness

First
Last
Name of Incident Witness

First
Last
Name of Incident Witness

First
Last
Description of Incident *
Primary Violation
 Alcohol Possession 
 Drug Possession 
 Noise Disturbance 
 Health/ Safety 
 Injury 
 Mental Health 
 Theft/ Loss 
 Vandalism 
 Conflict/ Dispute 
 Sexual Harassment 
 Sexual Assault 
 Disturbing Behavior 
 Trash 
 Property Maintenance 
 Parking 
 Trespassing 
 Risk Management  
 Recruitment Violation 
Report Filed By *

First
Last
Email *
Phone

### 		-
### 		-
####
Relationship to Campus *
Please Note:
By submitting this report, you acknowledge and affirm that all information provided is accurate and truthful. Filing a false report is a violation of the University of Utah Student Code and may have criminal implications as well. *
 All information provided is accurate and truthful. 
Image Verification
captcha
Please enter the text from the image:
[Refresh Image] [What's This?]
Powered byEMF Form Builder
Report Abuse
SUBMIT AN INCIDENT REPORT