Incident/Behavior Notice

IF THIS IS AN EMERGENCY, PLEASE CALL 911

Phi Sigma Sigma`s Emergency Number - (410) 530-1913

Phi Sigma Sigma aims to protect the reporter`s confidentiality, whenever possible. A report may be completed anonymously by omitting the reporter`s name and contact information from the form. Reporters should be aware, however, that this may restrict the Fraternity from completing a thorough inquiry/investigation.  Members of Phi Sigma Sigma are encouraged but not required to login before filling out this form.

Please fill out all applicable fields providing as much information as possible. This will allow the Fraternity an opportunity to offer the most effective, appropriate support.  After completing the form, please email any additional files or information to ibn@phisigmasigma.org. 

Thank you for taking the time to report your concern.

Please answer the following questions to the best of your ability. If exact date, time and place are unknown please indicate such.

Please indicate the campus/chapter involved
	NA Other Adelphi University - Epsilon Chapter Alma College - Theta Psi Chapter Bentley University - Zeta Delta Chapter Binghamton University of SUNY - Delta Xi Chapter Bloomsburg University of Pennsylvania - Epsilon Zeta Chapter Bridgewater State University - Epsilon Iota Chapter California State University, Bakersfield - Epsilon Epsilon Chapter California State University, Sacramento - Theta Chi Chapter California State University, Stanislaus - Theta Mu Chapter California University of Pennsylvania - Epsilon Tau Chapter Canisius College - Zeta Xi Chapter Capital University - Iota Omicron Chapter Carleton University - Zeta Eta Chapter Central Michigan University - Delta Iota Chapter Clarion University - Gamma Gamma Chapter Clarkson University - Gamma Mu Chapter Coastal Carolina University - Theta Beta Chapter Cornell University - Beta Xi Chapter Drexel University - Beta Rho Chapter Fairleigh Dickinson University at Madison - Zeta Theta Chapter Farmingdale State College - Iota Sigma Chapter Ferris State University - Epsilon Beta Chapter Fitchburg State University - Zeta Rho Chapter Florida Institute of Technology - Iota Eta Chapter Florida International University - Delta Kappa Chapter Grand Valley State University - Iota Iota Chapter Hofstra University - Epsilon Kappa Chapter Illinois State University - Epsilon Alpha Chapter Indiana University - Kokomo - Iota Epsilon Chapter Indiana University Southeast - Epsilon Chi Chapter Iona College - Delta Nu Chapter James Madison University - Iota Chi Chapter Keene State College - Theta Zeta Chapter Kutztown University of Pennsylvania - Zeta Omicron Chapter Lindenwood University - Iota Phi Chapter Linfield University - Delta Delta Chapter Loyola University Chicago - Zeta Tau Chapter McDaniel College - Gamma Psi Chapter Miami University of Ohio - Iota Tau Chapter Monmouth University - Delta Phi Chapter Montclair State University - Epsilon Theta Chapter Muhlenberg College - Delta Lambda Chapter Niagara University - Theta Omega Chapter Northern Kentucky University - Gamma Tau Chapter Northern Michigan University - Theta Alpha Chapter Nova Southeastern University - Theta Xi Chapter Oakland University - Delta Theta Chapter Pace University - Delta Omega Chapter Phi Sigma Sigma University - Omega Omega Chapter Queens College - Beta Pi Chapter Quincy University - Iota Beta Chapter Quinnipiac University - Zeta Zeta Chapter Radford University - Epsilon Phi Chapter Rider University - Theta Eta Chapter Rutgers University-New Brunswick - Gamma Nu Chapter Sacred Heart University - Iota Nu Chapter Saginaw Valley State University - Iota Alpha Chapter Salem State University - Iota Pi Chapter San Francisco State University - Delta Gamma Chapter Shippensburg University - Delta Chi Chapter Slippery Rock University - Zeta Nu Chapter Sonoma State University - Iota Xi Chapter St. John`s University - Epsilon Omicron Chapter St. Joseph`s University - Iota Rho Chapter State University of New York at Oneonta - Epsilon Xi Chapter State University of New York College at Oswego - Epsilon Nu Chapter Stevens Institute of Technology - Delta Zeta Chapter Stevenson University - Zeta Chi Chapter Syracuse University - Pi Chapter Temple University - Xi Chapter The College at Brockport - State University of New York - Delta Sigma Chapter The Pennsylvania State University - Beta Eta Chapter University at Buffalo - Delta Chapter University of Colorado at Colorado Springs - Iota Kappa Chapter University of Delaware - Delta Eta Chapter University of Findlay - Theta Nu Chapter University of Illinois at Chicago - Theta Delta Chapter University of Illinois at Urbana-Champaign - Theta Chapter University of La Verne - Theta Upsilon Chapter University of Maryland - Baltimore County - Gamma Pi Chapter University of Maryland - College Park - Beta Alpha Chapter University of Massachusetts-Dartmouth - Theta Sigma Chapter University of Michigan - Flint - Theta Iota Chapter University of Michigan at Dearborn - Zeta Omega Chapter University of Minnesota - Duluth - Iota Zeta Chapter University of New Hampshire - Iota Upsilon Chapter University of New Haven - Iota Mu Chapter University of Pittsburgh at Johnstown - Zeta Kappa Chapter University of Rhode Island - Gamma Zeta Chapter University of Virginia`s College at Wise - Theta Rho Chapter Virginia Wesleyan University - Epsilon Sigma Chapter West Chester University - Zeta Gamma Chapter Western Illinois University - Epsilon Psi Chapter Widener University - Gamma Xi Chapter William Paterson University - Delta Mu Chapter Woodbury University - Zeta Alpha Chapter Worcester Polytechnic Institute - Gamma Iota Chapter York College of Pennsylvania - Epsilon Rho Chapter

Please provide/update the following information so that we can contact you should additional information be required.
First Name:
Last Name:
Email:
Phone:	(XXX) XXX-XXXX

Please indicate your relationship relative to Phi Sigma Sigma and this notification. (Please answer by clicking on the checkbox next to all answers that apply.)

Check to Include As   Part of Your Answer    Alumna    Member    Neighbor    New Member    Parent    Peer/Student/Roommate    University Partner    Staff Member/Fraternity Volunteer    Other

Did the incident or behavior occur in a Phi Sigma Sigma house/facility/dorm?”
	Yes No

To the best of your knowledge, the incident or behavior
	Has already occurred Is anticipated to occur Is ongoing

What date and time did the incident or behavior occur (1000 character limit)

Location of incident or behavior (1000 character limit)

Please indicate the nature of the incident or behavior Please answer by clicking on the checkbox next to all answers that apply.

Check to Include As   Part of Your Answer    Alcohol    Social Event    Overnight Event    Individual Behavior    Respect & Human Dignity    "Little Sister" and "Little Brothers" Traditions    Multiculturalism/Diversity/Inclusion    Discrimination    Drugs    Recruitment    Sexual Misconduct    Financial    Sisterhood    Confidentiality    Hazing    Mental Health    Interpersonal Conflict    Disruptive Conduct    Harassment    Retaliation    Chapter Leadership    Advisor    Other - please detail as part of next question/answer

Names of members and/or new members involved: (1000 character limit)

Please describe the incident (1000 character limit)

Please attach additional documentation in the next section if necessary.

Please upload Supporting Documentation (photos, video, email, screenshots) - NOTE - You must click "Upload File" after selecting the file. If file format will not upload, please email files as attachments to IBN@phisigmasigma.org.

Attached Files     No documents uploaded.

To attach a new file, click Browse to locate the file on your local computer and then click Upload to upload the selected file. Note that you can upload multiple files if necessary/desired

Has there been any action taken to correct the situation? (1000 character limit)