S&T - Student Support and Community Standards

Reporting Party Information

Please provide your contact information. Your contact information will only be used by University officials if there is a need to gather additional information during the investigative process. The University will protect the identity of reporting parties to the best of their ability throughout the investigation.

Please note, reports may be submitted anonymously, but doing so may limit the ability of the University to investigate and take action.

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Your full name:

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Please provide your full first and last name

Your title/affiliation:

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Please provide your title or affiliation with respect to the concern being reported

Your phone number:

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Please provide a phone number to be used by the University to contact for additional information

Your email address:

Email address must be of a valid format.

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Please provide an email to be used by the University to contact for additional information

Your physical address:

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Please provide a physical address in the event the University needs to make contact with you

Nature of this report(Required):

This field is required.

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Please indicate if the report is concerning an individual or an organization

Date of incident(Required):

This field is required.

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Please provide a specific date in which the incident began

Time of incident:

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Please provide a specific time of day with respect to the date indicate when the incident began

Primary location of incident(Required):

This field is required.

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Please indicate where the concerning behavior took place from the list provided

Specific location:

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Please offer specific details concerning the location such as room number, parking area, etc.

Involved Parties

Please provide detailed information about each individual or organization that was involved in the incident being reported. Complete each of the field with information you know to assist the University in identifying the specific individuals involved

Name of the individual or the Organization

Select Individual's / Organization's Role

Student ID Number (if known)

Date of Birth (YYYY-MM-DD) (if known)

Phone number (if known)

Email address (if known)

Hall or Local Address (if known)

Additional Details Concerning the Incident

Please complete the following questions providing details concerning the behavior being reported that will assist in an investigation.

Please provide additional information concerning other locations in addition to the primary location listed above if applicable. This field is required.

Did University Police, Rolla PD, or another law enforcement agency respond to this situation?(Required)

University Police Rolla Police Department MO State Highway Patrol FBI Other Law Enforcement Agency None

You must make at least one selection.

Please provide a detailed description of the incident/concern using specific concise, objective language answering the following questions: Who was involved? What happened? When and where did everything take place? Why did the situation occur? How were you informed of the situation? Were there any important details leading up to the incident? Is there any other pertinent information to the incident in question?(Required) This field is required.

Supporting Documentation

Please include any additional documents to support the concerns reported such as pictures, video, documents, screen captures from cell phones or apps. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

S&T - Student Support and Community Standards - Incident Reporting Form

Reporting Party Information

Involved Parties

Additional Details Concerning the Incident

Supporting Documentation

Submission