Report

Name*
First Last
UFID

(if student/faculty)
Email*
Phone Number*
Date of Incident*
Time of Incident*

: Hours

Minutes

AM/PM
What organization was involved in the hazing?*
Location of Incident:*
Witnesses to the Incident:*

Please list all witnesses
Was anyone injured?*
- Yes
- No
Was alcohol involved?*
- Yes
- No
Were any organization advisors present? If so, who:*
Were any organization/team leaders present? If so, who:*
Were any team coaches present? If so, who:*
Please describe in as much detail as possible what happened:
I agree that the above statement is true and accurate to the best of my knowledge. I understand that I may be contacted by Student Conduct and Conflict Resolution to provide further information or serve as a witness for a student conduct hearing.
Electronic Signature*

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