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Documentation Form

All fields are mandatory with the exception of "Additional Information."

Date of Incident: Time:
: am   pm  
Location: Please be as specific as possible
(e.g., Kollen 230E, College East Apt B-7)
Individuals Involved:
First and Last Name, Local Address, Telephone Number
Student ID Number (if Hope student), Date of Birth
Person Submitting Form:
Must be a member of the Hope college community (non-Hope Community members should contact Campus Safety at 616.395.7770 to report concerns)
E-mail Address:
Brief Summary of Situation (1-2 SENTENCE MAXIMUM):

Detailed Description of Incident:
This form may be used as part of the College Judicial Process. The description should be fact-based, focus on 'Who, What, Where, When', contain no spelling or grammar errors and avoid personal opinion.

First and Last Name, Local Address, Telephone Number
Resources Used:
Campus Safety Campus Safety: 616-395-7770
Residential Life Coordinator RLC/RD Duty Phone: 616-283-0576
Neighborhood Coordinator  
Counseling and Psychological Services
Holland Police Department Should be contacted by Campus Safety
Other In case of emergency, please contact Campus Safety by dialing 911 from an on-campus phone or 616-395-7770 from a cell phone
None of the above  
**Additional Information:
Please provide any other pertinent information that will better enable an appropriate response.
Recommended Follow-up:
What action needs to be taken (e.g., follow-up by student's RD)

Indicate the facilities whose resident directors should receive a copy of this form:

Resident Halls:

Cook Hall Phelps Hall
Durfee Hall Scott Hall
Dykstra Hall Van Vleck Hall
Gilmore Hall Voorhees Hall
Kollen Hall Wyckoff Hall
Lichty Hall  

Cottage / Apartments:

College East Apts. East Green Neighborhood
Downtown Apts. West Green Neighborhood
South Campus Apts. North Lincoln Neighborhood
Centennial Neighborhood South Lincoln Neighborhood
North Dow Neighborhood South Dow Neighborhood Columbia Neighborhood


Any Academic/Other Building