Incident Information	Step 1 of 3
Use this report for: For Information Only For Action Date of incident: (mm/dd/yyyy) Time: (please specify am/pm)
Please provide information about the location of the incident, if possible.
On Campus Off Campus Campus building Residence hall Family Housing Co-op Classroom Other (please specify) On the street Restaurant Bar Home Fraternity Sorority Other (please specify) Specific Location: (name of building, street, residence hall, etc.)
The person intimidating, harrassing, and/or discriminating was:
Gender Student Status Male Female Unknown Other (please specify) UO Student UO Faculty member UO Staff member Non-UO Student Unknown Other (please specify)