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Student Rights and Responsibilities Incident Report Form

Call 911 then 303-871-3000
(1-3000, if calling from a campus phone)

Student Rights and Responsibilities
Student Rights and Responsibilities addresses possible violations of the Honor Code by undergraduate and graduate students. The conduct process is responsible for upholding the community values, striving to provide opportunities for student growth & development. For more information please visit our website: For Academic Misconduct incidents, please use the Academic Misconduct Incident Report Form.

Pioneers CARE Referral
If you have a concern about a student, but do not believe it rises to the level of a policy violation, you can submit a CARE Referral Form. This form can be used for reporting student behavior related to academic, social, and personal issues.

Reporting Staff & Faculty Concerns
To report matters involving only faculty or staff members, please contact Campus Safety at 303.871.2334.

If you are reporting a non-emergency incident which involves at least one student, please complete the following Incident Report to the best of your ability. Thank you!

Background Information

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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. ID Number = DU Student ID #. For non-students, please list a SSN or Drivers License number (if available) in the block labeled ID Number. **If more than 15 individuals are involved with the case, please include at least their name and ID at the beginning of the incident description, which is the next entry on this form.**

Incident Information

Please provide a detailed description of the incident/concern using specific, concise, and objective language

*NOTE: Your Incident Description will be sent to the student as is.

Incident Report Writing Tips:

* Complete the report thoroughly and accurately, including all pertinent information about the incident and persons involved (time, place, date, names, and addresses). The report should answer who, what, when, where, and how (e.g., how many beers, what kind, who is holding them, where the alcohol is in relation to the people, etc.)

* To avoid confusion about which individual you are referring to, use third person and identify individuals with their last name and title, when appropriate (e.g., Resident Johnson, RA Stevens).

* Be concise and to the point, while still being thorough and complete.

* Do not write from your emotion - leave editorial out. Use objective instead of subjective language.

* Do not speculate - you are reporting facts, not possible assumptions.

* Complete the report immediately after the incident - details fade fast.

* Make sure to proof read the text of your Incident Report before submitting.

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Medical Amnesty Question: If this situation involved alcohol or other drugs, was assistance intentionally sought by a student for themselves or others? Please provide further context in the Incident Description box above.(Required)
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Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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