Report a Concern
If you are concerned about the health, well-being or safety of a yourself, another student, faculty member or staff member please fill out all possible fields on this form.
All reports will be treated with discretion. Information from this form may be shared with appropriate individuals in order to help protect the safety and health of those involved in any incident. You may remain anonymous when reporting through this form. However, it’s very helpful to have your contact information and name in case there is a need to obtain more information about the situation or clarify information. Every attempt will be made to review and address the concerns you submit on this form, but without adequate information, the college may not be able to respond as effectively. Therefore your contact information is strongly encouraged.
Your phone number
I am a
Person of Concern
Please fill in as much information as possible. LEAVE INFORMATION BLANK IF UNKNOWN.
If you are referring yourself, please check this box. You can skip the contact information for the "Person of Concern" area
Person of Concern's Name
Is the person you are referring a:
Person of concern's email:
Person of concern's phone number:
Person of concern's S#
Nature of concern:
Mental health need
Suicidal/ Potential for self-harm
Potential of harming others
Student is in danger of being harmed
Shelter/ Housing needs
Room mate conflict
Urgency of your concern
Date of incident
Time of incident
Location of incident
Please describe your concerns in as much detail as possible. Use the person’s name, when known, rather than using pronouns (i.e., he, she, they, etc.) to identify people in your description. Indicate the specific words, phrases, interactions, or behavior that prompted this report.
Should be Empty:
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