Student Judicial Advisors Case Intake Form
*Please note that all information you provide in completing this form will remain confidential*
*Please send an email to thestudentjudicialadvisors@gmail.com upon completion of this form*
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First and Last Name *
Student Email
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Personal Email Address 
Name of Charge(s) - Please write out the charges exactly as listed in the email you received from the University! 
Were you charged by UW or by the Police?
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Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Location of Incident
Who were you reported by
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Was the incident affiliated with any sorority, fraternity, athletic team, or student organization?
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If yes, please explain. If no, please respond with "N/A"
Are there any additional parties to or witnesses of the incident involved?
Please provide a brief account of the incident
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