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´ºÓêÖ±²¥ Illinois University Greek Life Programs Hazing Report Form

Only with your permission, will your identity will be disclosed to the individuals or group in question. Your identity will be held in confidence. You may submit this form anonymously however; doing so will limit the ability of Greek Life to fully investigate the incident. You may be asked to submit an official statement on this matter and/or the case may be passed on to WIU Student Rights and Responsibilities.

Please check if you want to remain anonymous

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Reporter's Name:**

Reporter's Email:**

Reporter's Phone Number:** (XXX-XXX-XXXX)

Fraternity/Sorority involved in the incident:*

Date & Time of incident:*

Where did this take place?*

Individual involved in incident:*

What happened? (Provide as many details as possible.)*

What led up to this incident?*

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(*) - Required Information

(**) - Not Required if you check to remain anonymous

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