Honor System Conduct Referral Form

Referring Party

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Your full name:

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Campus box number:

Nature of referral(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (EXCLUDING yourself), complete as much information as possible. If your contact information is listed above, you do not need to add yourself to this section.

Name or Organization

Select Gender

Select Role

PID Number

Email address

Questions

Was this incident reported to UNC Police?(Required)

Yes No Unsure

You must make at least one selection.

UNCPD report #: (Format XXX-XXXXXX) This field is required.

Was this incident reported through an agency outside of the University?(Required)

Yes No Unsure

This field is required.

If answering "Yes" please identify the agency. This field is required.

Was this report submitted through the University's Hazing Hotline?(Required)

Yes No Unsure

This field is required.

Please enter a detailed narrative of the incident.(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

Referring Party

Involved Parties

Questions

Supporting Documentation

Submission