Chapter / Member Violation Reporting

Chapter / Member Violation Reporting
Your Name*

First NameLast Name
Position (Please Read All Options Carefully)*
Please read the following statements pertaining to this form. By checking the box beside of each statement you are acknowledging that you have read, fully understand, and agree to each statement.
Email:*
example@example.com
Phone Number:*
Please enter a valid phone number.Format: (000) 000-0000.
Which Council does Your Chapter belong to:*
Your CPH Chapter*
Your ETFC Chapter*
Your NPHC Chapter*
Please select who you are filing the report on behalf of:*

Which Council does the Chapter or Member you are filing a Report about belong to:*
Which CPH Chapter are you filing a Report on:*
Which ETFC Chapter are you filing a Report on:*
Which NPHC Chapter are you filing a Report on:*
Provide any other Specific Individual Members from the Chapter you are filing a Report on (if more than one please list one per row):
Example: Sholes, Zack
Regarding the incident you are reporting, were OTHER chapters (or their members) involved?*
Which CPH Chapter are you including in the Report:*
Which ETFC Chapter are youare you including in the Report:*
Which NPHC Chapter are you including in the Report:*
Provide any other Specific Individual Members and their Chapter that you are including in the Report (if more than one please list one per row):
Example: Sholes, Zack - Sigma Phi Epsilon
Estimated Amount of People involved in Incident:

Please select what you are reporting:*
Please list any specific portions of policy or relevant policy violations:
Approximate Date & Time of Incident:*

MonthDayYear
Date
Hour MinutesAM/PM Option
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Specific Name or Unofficial Name of Event where Incident took place:
Potential Witnesses (if more than one please list one per row):
I.E., Sholes, Zack (Sigma Phi Epsilon) - 423-297-2987

Please upload a Detailed Statement of Fact and Affidavit*

Write a descriptive and detailed recounting of the incident you are reporting (including names of those involved, witnesses, actions, recollection, reason for reporting, direct statements, timeline, locations, significant events). Provide a separate statement at the end of the document swearing that this is an honest and accurate description (to the best of your memory/perception) and conclude with your full name and current date.
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Please upload any evidence you have to support your claim (including screenshots, pictures, videos, conversations, social media posts, etc.):

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Should be Empty: