Student/Employee Full Name (First, Middle, Last):
Student ID/Employee Department (if available):
Student ID/Employee Email Address (if available):
Your Email Address:
Date of Incident:
Time of Incident:
Location of Incident:
Incident Reported Elsewhere:
Please provide a detailed description of the incident using specific,
concise, and objective language. Forward all the supporting documentations to the Student Conduct
Office at 44 CAF. Please call (661) 654-2680 with any additional questions.
To the extent possible, the identity of the reporting party and information provided will remain
confidential, but absolute anonymity and privacy cannot be guaranteed. The University may have an
obligation to use the information in subsequent proceedings. If you have any concerns about safety
or possible retaliation because you made a report, please inform the University Police Department.
President Mitchell invites you to share ideas and suggestions to help our campus achieve its vision of excellence.
Please share your thoughts with the Office of the President: email@example.com