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Yavapai College > Student Affairs > Student Code of Conduct > Incident Report Form -Verde

YC Student Conduct / Incident Report

(NOTE: to be used for incidents occurring on the Verde, Camp Verde, and Sedona sites ONLY)

Incident Filed by:
Date of Report:
Select One: faculty staff student other
Phone / Email Contact:
Incident Filed Against:
Student 1 name:
Student 1 ID#:
Email and/or Phone:
Student 2 name:
Student 2 ID#:
Email and/or Phone:
Student 3 name:
Student 3 ID#:
Email and/or Phone:
Incident Information:
Incident Location:
Date & Time of Incident:
Incident Description:
Describe the nature/basis for your complaint, including section(s) of the Code of Conduct/Residence Hall Handbook which have been violated, any response you have made to the incident, name(s) of other person(s) involved or witness(es), and any input you would like to have regarding the outcome or sanctions:

PLEASE NOTE: This form will be submitted via email to Barbara Duncan on the Verde campus. In most cases, your report will be reviewed and a response issued within 24 hours. If this is an urgent matter, please contact Campus Safety immediately by dialing 311.

This form is to be used to report a violation of the Code of Conduct.

NOTE: If a Campus Safety officer is involved, this report will supplement their report.

 
 


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