Incident/Behavior Notice


IF THIS IS AN EMERGENCY, PLEASE CALL 911


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
 
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
   Other
 
Did the incident or behavior occur in a Phi Sigma Sigma house/facility/dorm?”
 
To the best of your knowledge, the incident or behavior
 
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 - 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)