Residential Life & Housing


HOUSING INCIDENT REPORT

Grambling State University
Division of Student Affairs
Office of Residential Life


GSU Box 4309
Grambling, LA. 71245
Telephone: (318) 274-2504/Fax: (318) 274-4004

HOUSING INCIDENT REPORT

Nature of Incident:
Name of Individual Submitting Report:
Title (if any): Office/College/Dept:
Home/Office Phone Number: Cellphone Number:
Address/Building: Room: City/State/Zip:
Incident Date: Time: Location:
 
Name(s) of individual, student(s) or student organization(s) involved in alleged violation Student ID # Telephone/Cell Number Campus Address
 
Name(s) of witness(es) Student G # Telephone/Cell Number Please indicate status of witness:
Grambling State Faculty/Staff
Grambling State Student
Grambling State Faculty/Staff
Grambling State Student
Grambling State Faculty/Staff
Grambling State Student
 
Summary of Incident
Description of Incident (include only factual information- who, what, when, where, how, etc.):
 
E-mail Address: