Fillable Ir-behavioral-revised Incident Report (IR) California State University, Chico

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Ir-behavioral-revised Incident Report (IR) California State University, Chico

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12
Behavioral Incident Report
Student Conduct, Rights, and Responsibilities
California State University, Chico
Please type or print clearly
________________________________ __________________
Name of Student: Student ID Number
__________________________ __________________
Location of Incident Date of incident
Witnesses: __________________________ ________________________
Description of incident (include additional campus parties involved, ie: University Police, Department
Chair or Dean):
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
___________________________________________________________________________________________________________
Submit completed report by campus mail to zip 0105 or by email to: scrr@csuchico.edu. For questions,
please call (530) 898-6897.
Submitted by:
___________________ ____________________
Name Department
___________________ ____________________
Phone E-mail revised 3/2018
Type of incident:
(Check all that apply)
Alcohol/Drugs
Assault
Classroom
Disruption
Harassment
Non-Compliance
Theft
Vandalism
Weapons
Other
12
(Continued narrative) Student Name _________________________________
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Ir-behavioral-revised Incident Report (IR) California State University, Chico

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Completed 18 March 2020

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