WGTC KnightCARE Concern Form
BEFORE YOU BEGIN: If this is an emergency that involves an imminent risk of harm to self or others, please contact WGTC police at (855) 579-4357 or dial 911.Thank you for sharing your concerns for a student or employee at West Georgia Technical College. By sharing your concerns, you are helping to maintain a healthy and safe campus environment.Please use this form to report any concern you have about the safety of a WGTC student, employee or any member of the WGTC community, including yourself. This may include concerns about physical or mental health, relationship struggles, distress, problems with self-care, etc.The information on this form will be used to track and evaluate concerns to protect the safety, health and well being of the WGTC community.
Please enter your WGTC faculty or student email address:
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example@example.com
Last Name:
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First Name:
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Your role at WGTC:
Please Select
Staff member
Student
Faculty
Other
Phone number:
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Name of person you are concerned about:
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Where the concern occurred:
Date(s) concern observed:
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Month
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Day
Year
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Please describe your concern in detail:
Names of other persons who may have also observed the reported concern:
If there is any additional information you would like to include, such as screen shots, documents, etc. please email them to knightcare@westgatech.edu.
Submit
Should be Empty: