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Residential Life Report

Background Information

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Your full name:

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Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

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

Involved party 1

Name or Organization

Select Role

UB ID Number (if it starts with a 9, please write a 0 in front)

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how). This field is required.

Potential violations of the Code of Community Standards included in this report (check all that apply):

Alcohol - possession by a minor Alcohol - public intoxication Alcohol - drinking in presence of a minor Drugs - Possession of drugs Drugs - Possession of drug paraphernalia Guest Visitation Policy Violation Health and Safety Inspection Failure - misuse of room space Health and Safety Inspection Failure - prohibited item(s) Roommate Conflict Noise Complaint Physical Assault Other

You must make at least one selection.

If "other" selected above - please specify: This field is required.

Was a ResLife ProStaff Member involved/notified? This field is required.

Was Campus Security notified (if applicable)? 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.

Select copy recipients

Campus Security

Submission

Email me a copy of this report