Communication Information Form

Use this form to report incidents and issues that occur on campus or that affect members of the campus community. If you or anyone you know has been involved in an incident that you feel the college should be made aware of, please fill out this form to the best of your ability.

Contact the Office of Residence Life with any questions at 419-783-2563.

If you need immediate assistance, please call our crisis response phone at 419-439-0359.


For each person, please supply name, date of birth, building/room #, and cell number.

For each person involved, please supply alleged involvement code(s) from the list below.

Aggravated Assault (AGA)
Alcohol (AL)
Appliances (AP)
Arrest (ARR)
Arson (ARS)
Burglary (BUR)
Damage and Destruction (DD)
Disruptive Behavior (DB)
Drugs (DG)
Environmental Safety (ES)
Failure to Comply (FC)
Fire Safety (FS)
Guest/Visitor (GT)
Harassment (HA)
Medical (ME)
Medical Transport (MT)
Mental Health (MH)
Motor Vehicle Theft (MVT)
Noise (NS)
Other (OTH)
Person of Concern (PC)
Pets (PE)
Physical Assault (HRM)
Room Modification (RM)
Safety/Security (SY)
Sexual Assault (SA)
Solicitation (SO)
Student of Concern (SC)
Theft (TH)
Threat/Intimidation (TB)
Tobacco Products (TP)
Unauthorized Entry (UE)
Weapons (WP)
Wheeled Devices (WD)

The description should be completed by the person who files the complaint or those who witnessed the incident. Describe the incident with as much detail as possible. Include only the facts of the incident as observed or reported - not your opinion. Describe your role and actions in third person.

By submitting this report to Defiance College, I certify that the information given on this application is complete and accurate to the best of my knowledge.