Office of Judicial Programs
University of Maryland
Information Regarding Complaining Party (Person filing complaint)
Name:__________________________
Local Address:_________________________________________________
Local Phone:_____________________ E-Mail:__________________________
Information Regarding Student(s) Being Charged
Name:__________________________
Local Address:__________________________________________________
Local Phone:_____________________ E-Mail:__________________________
Date of Incident: __________Time of Incident:_________
Location of Incident:_____________________________
Please describe the incident exactly as it occurred. Include all information that may be relevant. (Use additional paper if necessary)
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Signed:__________________________ Date:________
Note: All participants are expected to refrain from public disclosure of reports filed with the Office of Judicial Programs. This information and the entire case file may be seen by the respondent (student charged).