Campus Incident Complaint

Your Information

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Your full name:

Your position/semester level:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Your role in incident(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide.

Name or Student Group Name

Select Role

Phone number

Email address

Hall/Address

Incident Description/Narrative

Please describe the incident, including date, time, place, person(s) involved, and any pertinent circumstances. Give all the salient facts supporting the report.(Required) This field is required.

Have you reported this information to the police?(Required)

Yes No

This field is required.

If you have not reported this information to the police, do you request that a Brown Public Safety Officer (or a dean of Campus Life) accompany and/or assist you to report this information to the police?(Required)

Yes No

This field is required.

Do you want a dean to contact your parent(s)/guardian(s) regarding this matter and explain to them the situation and the options which are available to you?(Required)

Yes No

This field is required.

I have read and understand the information contained in the introduction to this Campus Incident Complaint Form and I have read and understand the Brown University Code of Student Conduct for the current academic year. I understand the three (3) questions above and I have answered each of them truthfully. I understand that if I have any questions regarding any of this information, including the three (3) questions above, that it is my responsibility to meet and discuss those questions with a dean of Student Conduct & Community Standards prior to completing and submitting this Campus Incident Complaint Form.(Required)

Yes No

This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Your Information

Involved Parties

Incident Description/Narrative

Supporting Documentation

Submission