Butler University Smoke/Vape/Nicotine Free Policy Feedback

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The use of any form of tobacco, nicotine, or vaping/smoking device is prohibited on the Butler University campus. This includes all buildings (including residence halls), parking structures, campus walkways, university owned, leased or rented vehicles; and privately-owned vehicles parked on university property. This policy applies to all students, faculty, staff, contractors, vendors, and visitors to all university properties.

If you have comments or questions about this policy, please submit this form.

Email *

Relationship to Butler University *

Student

Faculty

Staff

Affiliate

Contractor

Visitor

Other

Please provide your first and last name: *

If you prefer to be contacted by telephone, please provide a telephone number:

Please provide your question or concern. *

A copy of your responses will be emailed to the address you provided.

Submit

Clear form

Never submit passwords through Google Forms.

reCAPTCHA

Privacy Terms

This form was created inside of Butler University. Report Abuse

Forms