Incident Report Form
Delta Delta Chapter at The University of Chicago
Thank you for contacting Delta Kappa Epsilon - Delta Delta Chapter
This form is meant for the reporting of minor incidents or suspected misconduct. You may wish to report to internationals instead, which can be done at https://form.jotform.com/252305287265054. Any person may report an incident or suspected misconduct by the Chapter or Member of the Fraternity. Based upon the information you provide, the Delta Delta Chapter will investigate and address your report as appropriate. Once you submit this form, you may be contacted by a member of the Delta Delta Chapter Officer Team, Such as the Current Vice President of Risk Management. If you wish not to be contacted, you may remain anonymous or report directly to international. Reporting party names and other personal identifying information are treated as confidential and are not released to any other member of the chapter, The University of Chicago student body, or any other person without a legitimate need to know. Reporting an incident anonymously or with incomplete details regarding the incident may limit the Fraternity's ability to respond to the report due to a lack of information. If you have any questions, please email risk@dkedeltadelta.org.
IF THERE IS IMMEDIATE RISK TO LIFE OR SAFETY, CALL 9-1-1
After, please call the international headquarters at 734-302-4210 and select the "crisis" option
Reporting Party Information
Please provide as much information as you are comfortable. Please remember that your information is kept confidential.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
What category best describes you
*
Please Select
Undergraduate Member
Associate Member (New Member)
Parent or Family Member
University/College Staff
Friend
Student Non-Member
Alumnus
Other
Incident Information
Please provide as much detail as possible and fully describe the incident.
When did/will the incident occur?
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date (If you are unsure, please use your best estimate)
At approximately what time did/will the incident occur?
Hour Minutes (If you are unsure, please use your best estimate) Minutes
AM
PM
AM/PM Option
Where, specifically, did/will the incident take place?
What are the general concerns related to this incident?
*
Alcohol/Social Event Management
Hazing
Sexual Misconduct
Drugs
Physical Assault
Administrative
Financial
Other
Who is involved?
Names & descriptions are helpful (John, my son/Brandon, the president)
Incident Narrative: Please be as detailed as possible.
*
"Who, What, Where, When" and describing behavior in detail
Please upload any supporting information
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