Student Conduct Intake Form This form provides some basic information to the George Mason University Korea Title IX Deputy Coordinator regarding Student Conduct concerns at George Mason University Korea. Please supply the information requested below and submit. This information will be viewed only by relevant personnel (i.e., Mason employees in, or connected to, the Office of Student Conduct). Name*Please provide your name.G Number*Phone* Home Work Mobile Email Address*Status of Charging Party*UndergraduateGraduatePart-time StudentApplicantFacultyStaffContractorJob ApplicantVisitor to CampusOtherPlease select an option that best describes your relationship with George Mason University.Basis of ComplaintCategories (Click all that apply)* Policy violation. Safety/security concern. Injury/illness. Other. ComplaintPlease provide some details regarding your complaint. This could include the name of an individual, their title, department or location of events that led to your complaint. This form is used to provide our office with some basic information about the nature of your complaint. You will be able to provide additional information to one of our providers during your intake interview.Respondent(s) Name(s)*Please provide the name(s) of the person(s) you are reporting.Respondent(s) GMU Email Address(es)*If multiple respondents, list email addresses in order of names listed in Respondent(s) Names(s).Respondent(s) Phone Number(s)*If multiple respondents, list phone numbers in order of names listed in Respondent(s) Names(s).Brief Account of Incident(s)*Describe the incident in detail. Include date and time of incident, the specific location, and the full names of all persons involved.Members and guests of the George Mason University community pledge to conduct themselves with integrity and honesty at all times. It is expected that all information presented will be true and correct. Members and guests of the George Mason University community who willfully and knowingly provide false information may be referred to the Office of Student Conduct for violating the University’s Code of Student Conduct or the appropriate authority. Furthermore, a pattern of lying or fabrication by the respondent may be considered when sanctions are decided upon in any case.