Office of Institutional Equity Incident Report

Information about you

Enable additional features by logging in.

Your full name:

Your role at the University:

Your phone number:

Your email address:

Your physical address:

Information about the incident(Required):

This field is required.

Learn more

Were you involved?

Urgency 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:

People Involved

Please include information about the Impacted Party and the Respondent.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Incident Details

What happened?(Required) This field is required.

Has any law enforcement agency been notified?(Required) This field is required.

If you answered "Yes" to the previous question, please indicate which agency.(Required) This field is required.

Has this been reported to any other Purdue Fort Wayne office or official?(Required) This field is required.

If you answered "Yes" to the previous question, please identify the office or official.(Required) This field is required.

Upload 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

Information about you

People Involved

Incident Details

Upload Supporting Documentation

Submission