Anonymous Assistance Form
If this is an emergency, immediately dial 9-1-1 or UM-Dearborn Police (313) 593-5333.

This form will only be viewed by both the current President and the current Faculty Adviser; not one or the other. This form is to allow the fraternity to help you, and to ensure the safety and integrity of our organization's members.

If you wish to bring the issue to collegiate attention, then please feel free to confidentially report to Counseling and Psychological Services (CAPS) at either (313) 593-5430 or umd-counseling@umich.edu.

Please be safe and do not be afraid to ask for help in any situation you may find yourself, or others, in.

Note: You will not recieve a follow up on this form, as filling this out you choose to remain anonymous. If you wish to recieve a response, please reach out the the EBOARD.
What subject best explains the incident you or another brother/pledge/alumni is in need of assistance? *
If you selected other, please explain.
Your answer
Please explain to your closest approximation WHEN did you first become aware of this issue, or when do you believe this issue may occur. *
Your answer
Please explain WHERE the issue occurred to your closest approximation, or where you believe the issue may occur. *
Your answer
Please explain in as much detail as possible, WHAT happened, or what you are worried about happening. *
Your answer
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