Norfolk State University's ability to investigate a hazing incident, enforce the University’s values and expectations, and protect the interests of students depends upon the accuracy and specificity of the information provided in this report. You are encouraged to provide as much detail as possible so that appropriate action can be taken to address the reported behavior. You have the option to submit this report anonymously, though campus officials and law enforcement may be unable to complete a thorough investigation without knowing the source of the report. Please note that false reports impede the ability of the University to meaningfully address legitimate hazing concerns. If you feel that someone is in immediate danger, please contact the Norfolk State University Police Department at (757)823-8102.

A note on privacy
This survey is anonymous.
The record of your survey responses does not contain any identifying information about you, unless a specific survey question explicitly asked for it. If you used an identifying token to access this survey, please rest assured that this token will not be stored together with your responses. It is managed in a separate database and will only be updated to indicate whether you did (or did not) complete this survey. There is no way of matching identification tokens with survey responses.
Incident Report
*1 1. What is the name of the organization that you are reporting for committing acts of hazing? 

*2 2. On what date did the incident(s) occur?  

*3 3. At what time did the incident(s) occur? 

Help Please enter the approximate time
*4 4. Where did the incident(s) occur? 

HelpPlease enter City, State
*5 5. Who were the individuals involved in the hazing acts? 

*6 6. Are there any individuals that witnessed the incident(s) or can further support your report? 

*7 7. Describe the nature of the incident 
Check any that apply
*8 8. Did any injuries occur as a result of this incident? If yes, please specify. 

*9 9. Please describe the hazing act(s) that you are reporting. Provide as much detail as possible.  

Contact Information *This Section is Optional*

As a reminder, reports from anonymous sources may hinder the ability for campus officials to thoroughly investigate and address a hazing incident.  

10 10. Your Name  

11 11. Your phone number.  

12 12. Your email address.