Hazing Reporting Form
Email address *
Do you wish to remain anonymous? *
IMPORTANT
It should be noted that this report will not be reported to the Office of Student Conduct or any other administrative body outside of the University Honor Council if the incident in question has occurred in the past and is no longer ongoing. However, if the described hazing is still occurring, it may be reported to the Office of Student Conduct.
Date you learned about incident (MM/DD/YY) *
Your answer
Name of the perpetrating group or individual *
Your answer
Date of Incident (MM/DD/YY) *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Have you reported this incident to other Penn offices? If so, please list them below: *
Your answer
Location of Incident: *
Please provide the name of the location or describe it below. *
Your answer
Type of Incident (What types of hazing were involved?) *
Your answer
Basis of Incident. (Why do you believe this incident occurred?) *
Your answer
Do you believe you were individually targeted? *
Your answer
Description of the incident (Please provide as much detail as possible): *
Your answer
Is there anything else you would like to add about the incident? *
Your answer
You may provide your name and request that it be held in confidence as the inquiry goes forward. If you request that your identity remain confidential, the person handling the inquiry will do so to the extent practicable and permitted by University policy and applicable laws. Penn’s ability to investigate allegations of misconduct and to take corrective action may be impeded if your identity is not provided to the person responding to the complaint. Depending on the nature of the allegations(s) raised (e.g. unlawful discrimination or sexual violence), conducting a fair and complete investigation may require that the full details of the incident, including your identity be shared. In those instances, all parties will be advised of the University’s policy against retaliation for making complaints. *
Your answer
Name
Your answer
Penn Affiliation
Your answer
Email
Your answer
Phone
Your answer
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of The Wharton School. Report Abuse