University Incident & Student Complaint Form

Background Information

Your full name:

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Or, you may write Anonymous

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your Physical Address:

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

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Room and/or Apartment Number

Involved Parties

Please fill in the information you can provide about ALL of the individuals involved (including yourself). Please be sure to collect Banner IDs if possible.

For non-students, please list a Drivers License or State ID number in the block labeled Banner ID Number. If the DL or state ID is from a state other than North Carolina, please begin the ID with the state abbreviation. (ex. Wisconsin=WI). If no Drivers License or State ID number is available, please list their first and last as one word with no space (FirstLast) in the block labeled Banner ID Number and if available AND list what school/university they attend in the hall/address field.

UNIVERSITY EMPLOYEES, WHEN YOU ENTER YOURSELF IN THE REPORT, YOU MUST ENTER YOUR BANNER ID NUMBER.
WHEN ENTERING FSU PD, LIST THEIR FIRST AND LAST NAME AS ONE WORD WITH NO SPACE (FIRSTLAST) IN THE BLOCK LABELED BANNER ID

SELECT ROLE DEFINITIONS
"Selected role" denotes the role the person played in the incident report NOT their role as a campus employee.

Alleged - the person who is accused of violating University conduct or Residence Life policy.
University Faculty or Staff - person who is employed at the university as faculty or staff.
Victim - the person who suffers from some adverse circumstance by the alleged party.
Witness - the person who saw the incident but wasn't directly involved.
Complainant - the person making a complaint against another person.
Res Life Staff - a person who is employed by the Department of Residence Life either as a Resident Assistant, Community Support Associate (CSA), or Resident Director.
Other - Anyone role not listed.

Name or Organization

Select Gender

Select Role

Banner ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Background Information

Involved Parties

Questions

Supporting Documentation

Submission