Emory University Hazing Reporting Form

Name of Reporting Person Name of Reporting Person First Last
Reporter Contact Information (Email and/or Phone Number)
Date of incident Date of incident / MM / DD YYYY
Time of incident Time of incident : HH MM AM/PM
Location of incident
Type of organization
Person or Organization alleged to be involved in the incident
Your relationship to those involved
Description of incident

Please summarize the facts in as much detail as possible. Describe all comments, conduct, gestures, physical injuries, property damage, etc. Identify individuals by name, if known, or by physical appearance, if name unknown. List any possible witness(es) by name and contact information, if known.
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I certify that this information is accurate and truthful.

I certify that this information is accurate and truthful. Yes
If the reported behavior involves active behavior, please contact Emory Police Department immediately at 404-727-6111.