Office of Student Conduct

Current Date:*

Date of Incident:*

Your Name:*

Address:*

Phone Number:*

Email Address:*

INDIVIDUALS INVOLVED IN INCIDENT

Individual 1:

Name:*

Address:

Email Address:

Individual 2:

Name:

Address:

Email Address:

Individual 3:

Name:

Address:

Email Address:

Individual 4:

Name:

Address:

Email Address:

Individual 5:

Name:

Address:

Email Address:

VICTIM/WITNESS

Individual 1:

Name:

Address:

Email Address:

Individual 2:

Name:

Address:

Email Address:

Individual 3:

Name:

Address:

Email Address:

Individual 4:

Name:

Address:

Email Address:

Individual 5:

Name:

Address:

Email Address:

Please provide a detailed description of the incident using specific concise, objective language.*

Any additional supporting documentation (photos, video, email, Word documents, etc.) should be forwarded immediately to the Office of Student Conduct at studentconduct@uncp.edu.

By clicking the "Submit" button below, I certify that the statements herein are true. I further understand that providing false information will cause action to be taken by the Office of Student Conduct that could result in sanctions, including suspension from the University.