Public Incident Report – U Asia Campus

To share information about a possible violation policy, please complete the form below. WARNING: If this is a time sensitive issue, please CALL one of the following offices for a more immediate response: Campus Police (emergencies 112) Dean of Students Office 032-626-6006. By submitting this report, you acknowledge and affirm that all information provided is accurate and truthful. Knowingly filing a false report is a violation of the University of Utah Asia Campus Student Code. You do not have to provide your name.

Public Incident Report Form

I am *

Please choose an item from the pulldown that describes your affiliation with the University and the nature of your report.

Full name of person making the report (optional)

Reporter's Email (optional)

Reporter's Phone Number (optional)

Date of incident *

Time of incident *

Description of the incident/observed behavior. *

Please include a description of the incident or observed behavior, include as much of the following as you can Student, faculty or staff member’s name and ID number (if known) Direct quotes whenever possible. Where and when the incident or behavior occurred. Names and contact information of witnesses. Your name, position and complete contact information. Include all emails or other information you have. Always save voice recordings, text messages and emails on the device that received them.

Names of students involved.

Location of the incident.

If you are human, leave this field blank.