Incident Report Form

Incident Report Form
This form is used to report complaints of sex discrimination, sexual harassment, sexual assault, and retaliation in accordance with policies and procedures pertaining to the Student Code of Conduct (Board Policy, FLB (Local) - located at https://pol.tasb.org/Policy/Search/649?filter=FLB%20Local ;Discrimination, Harassment and Retaliation-Sex and Sexual Violence (Board Policy, FFDA (LOCAL) – located at https://pol.tasb.org/Policy/Search/649?filter=sexual%20harassment ;and/or Clery Act Reportable Crimes located at https://www.hillcollege.edu/Safety/CleryAct.html.
Background Information
Name

First NameLast Name
Your position/title:
Phone Number

Area CodePhone Number
Email
example@example.com
Physical Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nature of this report:*
Please Choose...
Urgency of this report:
Date of incident*

MonthDayYear
Time of incident

:HourMinutesAM/PM Option
Location of incident:*
Specific location:
Involved Parties
Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an SSN or Drivers License number in the block labeled ID if available.
Name of Organization/Sport/Department
Select Gender
Please Choose..
Select Role
Please Choose..
ID Number
Date of Birth

MonthDayYear
Phone Number

Area CodePhone Number
Email
example@example.com
Address or Residence Hall

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Questions
Below are categories that correspond to the Student Code of Conduct (Board Policy, FLB (Local) - located at https://pol.tasb.org/Policy/Search/649?filter=FLB%20Local;

Discrimination, Harassment and Retaliation-Sex and Sexual Violence (Board Policy, FFDA (LOCAL) – located https://pol.tasb.org/Policy/Search/649?filter=sexual%20harassment;

and/or Clery Act Reportable Crimes. Please check all relevant sections, charges and/or crimes that pertain to this incident report, if applicable
Academic Dishonesty

CheatingPlagiarismCollusion
Behavioral Intervention Team

AggressionAnxietyDepressionEating DisorderDisturbed WritingHeightened Emotional Distress/HostilityMood Swings/Intense Emotional OutburstsSelf HarmSuicidal Attempts/BehaviorThreats (Direct or Veiled)Withdrawal from Social Group
Clery Act (Violence Against Women Reauthorization Act of 2013)

Aggravated AssualtAlcohol/Liquor ViolationArsonBurglaryMurder/Non-negligent manslaughterNegligent ManslaughterDating/Relationship ViolenceDomestic/Family ViolenceDrug ViolationsHate CrimesIntimidationMotor Vehicle TheftRobberySex Offenses: ForcibleSex Offenses: Non-ForcibleSimple AssaultStalkingTheft (Larceny)Vandalism/Property DamageWeapons Violation
Nonacademic Misconduct

DiscriminationDisruptive Behavior/Disorderly ConductDrugs and AlcoholEndangermentFailure to ComplyFalsification/FraudFire and SafetyGamblingHarassment (nonsexual)HazingPets and AnimalsRecreational/transportationPostings/SolicitationProperty (defacing, damaging, misusing or destroying)RetaliationSexual Misconduct (Harassment, Violence)Smoking/TobaccoTechnology MisuseProhibited WeaponsStealing/Theft
Supporting Documentation
Other Violation
Photos, video, email, and other supporting documents may be attached below. 1GB maximum total size. Attachments require time to upload, so please be patient after submittingthis form.
Choose Files to Upload

Browse Files

Cancelof
Enter the message as it's shown*
Should be Empty:

Incident Report Form

Background Information

Involved Parties

Questions

Supporting Documentation