This report is for NON ACADEMIC MISCONDUCT ONLY, which handles resolution through the Office of the Dean of Students. This report does not constituent a police report nor an academic misconduct report. To file a police report, please contact the Department of Public Safety at 708-534-4900; for academic misconduct report, please contact the Office of the Provost at 708.534.4980.

Reporter Information

Classification: 

First Name: 

Last Name: 

Email Address: 

Campus Address: 

Phone Number: 

Incident Information

If there are multiple incidents, please fill out a new incident report form for each incident

Did the incident take place at Prairie Place 

Date & Time of Incident

 [None] Select a Date Delete the Date 

Location of Incident: 

Nature of Incident: 

Quick Description of incident:

    

Persons Involved Information

#1 

 Classification:  Level of Involvement:  Underage (under 18 years old:                

 First Name: 

Last Name: 

GSU ID #(if available): 

#2 

Classification: Level of Involvement:   Underage (under 18 years old: 

First Name: 

Last Name: 

GSU ID # (if available):

#3 

Classification: Level of Involvement:   Underage (under 18 years old: 

First Name: 

Last Name: 

GSU ID # (if available): 

Others involved:   

Additional Information  

Was alcohol involved? 

Were drugs involved? 

Was DPS/911 called?  If yes, Officers Name: 

Was EMT/ambulance involved? 

Was the ARC counseling office called? 

Was the Dean of Student’s office called? 

Was the Resident Director called/informed?