A Student Conduct Incident Report documents potential violations of University policy. If you have witnessed an incident which you believe has violated University policy, please fill out and submit an incident form. You can do this on-line or by contacting the Center for Student Ethics and Standards, Police Services, or your Residence Director.

To submit an on-line incident report, please fill out the following form completely. We do not accept anonymous incident reports for student conduct. Once your report is reviewed by the Center for Student Ethics and Standards, we will contact you to verify its authenticity.

Should you have any questions about this matter or the student conduct process, please contact the Center for Student Ethics and Standards at 802-656-4360 or stop by our office at Nicholson House, 41 South Prospect Street (next to Waterman).

Documented by (Your First and Last Name):

Your Student ID (95XXXXXXX) Number:

Your Cell Phone Number:

Your UVM Email Address:

Were the UVM Police Involved?

1. Yes
2. No

If yes:

Police Report Number:

Name of Officer:

Incident Date:

Time of Incident:

Was Alcohol Involved?

1. Yes
2. No

Were Illicit Drugs Involved?

1. Yes
2. No

Location of Incident: Athletic Facilities Austin Buckham Chittenden Christie Converse Coolidge Davis Center Davis Hall Hamilton Harris Jeanne Mance Living/Learning Marsh Hall Mason Millis Patterson Redstone Hall Simpson Slade Trinity Tupper University Heights North University Heights South Wilks Wills Wing Wright Other - On Campus Off Campus

Names, Addresses, and Phone Numbers of all People Involved in the Incident:

Names, Addresses, and Phone Numbers of all Witnesses (if any):

Narrative: (Please be as detailed and specific as possible.)

If you need additional space, please send in a follow-up email to CSES.

Thank you.

Created/Last revised: August 9, 2012
Author: Sue Pochop