Incident Reporting Form

The Division of Student Affairs (DSA) at Arkansas State University Campus Queretaro administers the Non-Academic Standards of Student Conduct, which identifies behavioral expectations for all students on- and off-campus. These standards can be found in the Student Handbook (pages 39 – 56):

If you have knowledge of an A-State CQ student violating these Standards, you are encouraged to notify our office of the incident. Once a complaint has been received by DSA, our staff will meet with the student to address the alleged misconduct. Upon an investigation, appropriate action will be taken.

Please know that you and the witnesses you identify in the report might be contacted by DSA staff for further information about the incident. If you have any questions regarding filing an incident report, please contact DSA at

Background Information

Please fill out the following information with your contact information. Members of the Residence Life staff should make sure to include the building, hall or area in which they work. Faculty and Staff should include their department or college.

Involved Parties

Please list ALL of the people involved in this incident (excluding yourself). Please include as many of the listed fields as you can provide. For non-students, please list IFE/INE, CURP or Driver License numbers in the block labeled ID Number if available. Residence Life Staff MUST include the SIDs of all students involved. Please remember to put the people involved into the system in the order they are placed in the drop down box.

Description /Narrative

Please provide a detailed description of the incident/concern using specific, concise, and objective language (who, what, where, when, why, and how). Be as specific as possible when describing the incident/concern

Was campus security notified or did they respond? YesNo

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

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