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ResLife ProStaff Incident Summary Statement

This form is to be used by the ResLife ProStaff Member to provide a summary statement of any incidents addressed by them at the University of Bridgeport. This document is not to be construed as the formal incident report regarding situations; instead, as supplemental material provided by members of the Office of Housing, Residential Life and Community Standards.

Staff Member Information

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Your full name:

Your position/title:

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Name or Organization

Select Role

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

Hall/Address

Report Information

Supporting Documentation

Please attach any supporting documentation at this time. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

Campus Security

Staff Member Information

Involved Parties

Report Information

Supporting Documentation

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Submission