Stop the Hazing Act Reporting Form

Please provide detailed information regarding the incident you are reporting involving a Miles College student.

With regard to reports of alleged Code of Student Conduct violations, university conduct records are protected by a federal privacy law called the Family Educational Rights and Privacy Act (FERPA), therefore, any information regarding the outcome of this report will not be shared with you without the direct written consent of the student(s) involved.

Title

First

Middle

Last

Suffix

Your position/title

Nature of this report (Required)

Code of Student Conduct

Hazing Report

Date of incident (Required)

Time of incident

Location of incident (Required)

Specific location

Please provide a detailed description of the incident (Required)

How was each individual listed above involved in the incident? (Required)

Who else had knowledge of the incident(s)?

hat action, if any, was taken after the incident? (Required)

Please provide a brief summary of each conversation or interview conducted and the information obtained. (Required)

Has this been reported to the police/law enforcement? (Required)

Supporting Documentation: Attachments require time to upload, so please be patient after submitting this form.

One file only.
256 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, mp4, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Stop the Hazing Act Reporting Form

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