TEXAS A&M UNIVERSITY-TEXARKANA
Student Incident Reporting Form

Note: The information stated in this form may be used in University conduct proceedings and/or civil court proceedings. The accused student has the right to view this document if he/she is being charged for alleged violation of the Student Code of Conduct.

* denotes required information
Information
     
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 You may file anonymously, however, the Division of Student Life may not be able to follow up on your complaint should you choose to do so.  
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Type of Incident
     
  Type of Incident (Check all that apply)

 
 
DisruptionSexual Misconduct
Misuse of computer resourcesPossession or consumption of alcoholic beverages by minor
Damage/Misuse of University PropertyHarassment
Illegal use or possession of drugs or illegal substancesAcademic Dishonesty
Threatening actions (Verbal/Physical)Other: 

 
     
Students Involved
     
 Student(s) InvolvedUniversity ID No. AddressTelephone 
  
  
  
     
Witnesses
     
 Witness(es) to IncidentTelephoneAddressStudent? Yes/No 
 Yes  No 
 Yes  No 
 Yes  No 
     
What Happened
     
 
*Required
 
     
Signature

 By submitting this form, I hereby acknowledge that the information provided in this report is complete and true to the best of my knowledge and that the designated Judicial Officer will review the incident to determine an appropriate response. I understand that by informing the Division of Student Life that some incidents, particularly sexual assault or other incidents that are deemed egregious by the Division of Student Life, may be subject to emergency action. The Division of Student Life upholds FERPA in all matters. By submitting your signature you are also acknowledging that the University will determine what information may be shared as educational need-to-know in the investigation of this complaint.



State law requires that you be informed of the following: (1) you are entitled to request to be informed about the information about yourself collected by use of this form (with a few exceptions as provided by law); (2) you are entitled to receive and review that information; and (3) you are entitled to have the information corrected at no charge to you. For more information see our Privacy Statement.