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Report a Hazing Incident

Reporting a Hazing Incident

Information Regarding Complainant - Individual who experienced hazing

If you wish to identify yourself, please provide the information requested below. You may choose to remain anonymous.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Information Regarding Reporter - Individual reporting the incident(s)

If you are making this report on behalf of someone else, please complete the information below.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Information Regarding Respondent(s) - Individual(s) the complaint is against

Please provide any details known.

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Any additional details:

Information Regarding Incident(s)

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Date of incident: *

Time of incident:

Location of incident (If on campus, please provide specific building and room number if available):

Description of incident - Please provide as much detail as possible: *

Potential Witnesses to the Incident(s) and Others with Knowledge of the Incident(s)

Please include the name and any known details for each:

Name:

Phone number:

Email address:

Relationship with Lake Land College:

Any additional details:

Was a police report filed about the incident(s)?
No Yes
Have you discussed the incident(s) with any college official?
No Yes

If so, whom?

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After submission of this form, you will receive an email acknowledgement with additional information regarding resources available to assist you immediately and resources to follow-up with at Lake Land College. If you have provided your contact information, a college staff member will follow-up with you on the next business day.

By checking the box below and submitting this form, you certify that the information you have provided is true and accurate to the best of your knowledge.

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