SDSM&T
Information Report
Office of Residence Life
 
 

Please list the day, date, time and location of the incident.
Day
Time
Room / Location

Individuals involved:
(Please print each individual’s name and place of residence, i.e. hall name & room number, off-campus, non-student)
 
 
 

 Was the Hall Director notified?   Yes    No
Was Campus Security notified?   Yes    No
Were Rapid City Police notified?   Yes    No
 Was the Director of Residence Life notified?  Yes    No
Was the Associate Dean of Students notified?   Yes    No
Was medical attention necessary?   Yes    No
 

Description of the incident.  Be specific and include names of individuals involved. Write in first person.
 

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Person(s) Filing Report

Please file with your Hall Director within 24 hours of the incident.
 
 

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