DOS Student Conduct & Community Standards

Your Information

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Your full name:

Your UIN:

Your phone number:

Your UIC email address:

Email address must be of a valid format.

DOS Case Number:

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Listed on any email correspondences from our office

Purpose of Statement(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

Name or Organization

Select Gender

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UIN

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Your Narrative

This is where you get to share your perspective on the incident(s) in question. Your side of the story helps to paint a larger picture of what may have occurred. We encourage you to be as detailed as possible. Many find it helpful to present your information in the format of a story (What happened from the time you woke up until after the incident happened, who did what, who observed what from what vantage point). Share any and all information you believe would be important for any hearing body to know.

You may provide a complete description of your involvement in the incident, including any additional information you believe is relevant.(Required) This field is required.

Is there other information (e.g., a background story that explains the context, information you have come to learn since this incident, etc.) that you would like to provide? This field is required.

BY SIGNING THIS STATEMENT, I hereby assert that the statement attached is true and may be shared with the Complainant, Respondent, Registered Student Organizations (RSOs) directly involved, Hearing Officer, and any faculty, staff, and students members serving on a Student Conduct Committee Members (if applicable). Your digital signature has the same legal effect and consequences as a handwritten signature. Please type your full name(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

DOS Student Conduct & Community Standards - Respondent RESPONSE Form

Your Information

Involved Parties

Your Narrative

Supporting Documentation

Submission