OSC_Personal Misconduct Form

Name First Last
Title (if applicable)
Department *
Email
Phone - Area Code - Prefix Line Number
Affiliation Staff Faculty Student Community Member
Complaint Information
Date of incident / MM / DD YYYY
Time of Incident : HH MM AM/PM
Location of incident *
Did this occur on campus? Yes No
Please list the name(s) and ID number(s) of student(s) involved
Type of misconduct * Click the link at the top of the page for misconduct type definitions

Click the link at the top of the page for misconduct type definitions
Description of Misconduct: (Please list a summary of the allegation(s), any witnesses that should be contacted, and be as specific as possible)
Verification and Understanding of Filing a Complaint
Checkboxes I spoke to the student/faculty/staff member in person regarding this complaint. I understand that under some circumstances the Office of Student Conduct may have the right and obligation to pursue a complaint if you choose to report something as "information only" or anonymously. I agree that the above information is true and I can be charged for false reporting by the Office of Student Conduct in the future if the report is known to be false.