Student Rights & Responsibilities - Incident Report Form

University of Central Florida
Office of Student Conduct- Incident Report Form

Reporting Person/Agency/Department
NOTE: Anonymous submissions of incident reports will not be processed by the Office of Student Conduct.

Name:

Phone:

E-mail:

UCFPD ( OCSO SCSO)

Administrative Dept

Academic Dept

Student Other Club/Organization

Student Information Name:	PID:
Local Address:
Local Phone:	Date of Birth:
Witness Information - 1 Name:	PID:
Local Address:
Local Phone:	Date of Birth:
Witness Information -2 Name:	PID:
Local Address:
Local Phone:	Date of Birth:

Incident Type

Academic Dishonesty/Cheating
Possessing/Providing False Info/ Records
Disruptive Conduct
Personal Abuse
Sexual Misconduct
Larceny/Property Damage
Hazing
Unauthorized Use of Keys/Entry
Misconduct at UCF Related Functions

Controlled Substances (Drugs)
Alcoholic Beverages Violation
Firearm or Dangerous Material
Group Disturbance during Events
Computing/Telecommunications Misuse
Gambling
Student Residence Violations
University Wordmark Violations
Violation of Local, State and/or Federal Law

Incident Description

On-Campus: Off-Campus:

Date: Time: : Location:
Specific Description of Incident

Incident Report for Information Purposes ONLY
Incident Report to for Information Purpose & Ethics Seminar ONLY
Incident Report to initiate the Student Conduct Review process

Additional Pages Coming Arrest Report Coming

Please note that once this incident report is submitted, the Office of Student Conduct can only notify you of the progress of the case. If the case goes to a formal hearing, you may be asked to serve as a witness at that hearing.

For Faculty/Staff: Due to FERPA regulations, the Office of Student Conduct is only allowed to disclose certain information regarding conduct cases. Based on these regulations, the Office will notify any instructors who have an educational need to know if a student of theirs has been suspended or expelled from the university.

For University Police: Due to FERPA regulations, the Office of Student Conduct is only allowed to disclose certain information regarding conduct cases. Based on these regulations, the Office will notify the Police Department of any student who has been trespassed from the University or deemed "persona non grata".

Office of Student Conduct
- Ferrell Commons, Rm 142 -
(407) 823-2851

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