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Incident Reporting Form

Non-Disciplinary Student Behaviors of Concern

If an observed behavior involves a matter of very urgent concern, including imminent danger, immediately contact University Police at 724-357-2141 or the appropriate emergency services provider at 911 (or 9-911 if dialing by campus land-line telephone).

Please provide detailed information regarding the observed behavior of concern or incident involving an IUP student. The use of this form is limited to enrolled students and current members of the faculty, staff, and administration. IUP does not accept anonymous reports. Please be aware that you and the other persons identified may be contacted to provide further information and/or assistance. Action taken as a result of this report may be protected by federal privacy law (Family Education Rights and Privacy Act) and therefore become confidential information unless otherwise specified by the named student(s).

Questions regarding the filing of this form can be directed to the Office of the Vice President for Student Affairs at 724-357-4040. Do not use this form to report potential violations of the Student Code of Conduct. Instead, directly contact the Office of Student Conduct at 724-357-1264 or at 307 Pratt Hall.

All fields are required unless otherwise indicated

About You











About the Incident


 [None] Select a Date Delete the Date





(If appropriate and known)

Observed Non-Disciplinary Behavior(s)

Please check all observed non-disciplinary behaviors of concern that apply. Do not use this form to report potential violations of the Student Code of Conduct. Instead, directly contact the Office of Student Conduct at 724-357-1264 or at 307 Pratt Hall.

  1. (Please specify in the detailed description section below)

Please list all involved persons (excluding yourself) and include as many of the listed fields as you can provide.






 [None] Select a Date Delete the Date











 [None] Select a Date Delete the Date







Please provide a detailed description of the observed non-disciplinary behavior of concern or incident using specific, concise, objective language.

Any additional supporting documentation related to observed non-disciplinary behaviors of concern should be forwarded to the Office of the Vice President for Student Affairs in Sutton Hall, Suite 211-216 or by e-mail to rluckey@iup.edu.

 

  • Student Affairs Division
  • Sutton Hall, Suite 211-216
    1011 South Drive
    Indiana, PA 15705
  • Phone: 724-357-4040
  • Fax: 724-357-4977
  • Office Hours
  • Monday through Friday
  • 7:30 a.m.–12:00 p.m.
  • 1:00 p.m.–4:00 p.m.