Student Threat Assessment Team Reporting

1
Do you wish to remain anonymous?* This field is required.Note that if you answer yes to this question, it makes it very difficult to bring a resolution to the situation. It makes it impossible to request more detailed information from you.
YESNO
2
What is your name?* This field is required.
First Name
Last Name
3
What is your UMHB ID Number?
4
What is your UMHB email address?* This field is required.
example@example.com
5
What is your cell phone number?* This field is required.
Area Code
Phone Number
6
I am a:* This field is required.
Student
Faculty
Staff
Parent
Visitor
Other
7
Type of activity reporting:* This field is required.If you need to report an incident of rape, sexual abuse or sexual violence, please contact either the Title IX Coordinator at (254) 295-4527 or susan.owens@umhb.edu.
Criminal Activity
Mistreatment
Safety Concern
Substance Abuse
Theft
Threatening Behavior
Violation of University Policy
Other
8
Location of incident* This field is required.
9
Approximate Date* This field is required.
Date
Year
Month
Day
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Approximate Time* This field is required.
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Hour
00
10
20
30
40
50
Minutes
AM
AM
PM
11
Incident Description* This field is required.
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Ok
Ok
12
Please list individuals you think may be involved.* This field is required.Please list the first and last name of at lease one individual. If there is no specific person OR you don't know the first or last name of an individual, please enter "unknown" in the field. Please indicate if any of these are not affiliated with UMHB.
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Ok
13
Did the event occur more than once?* This field is required.
YESNO
14
How many times did this occur?* This field is required.
15
Were you directly affected by this situation/behavior?* This field is required.
YESNO
16
How were you affected?* This field is required.
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Ok
17
Was anyone injured?* This field is required.
YESNO
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Please describe the nature of the injuries.* This field is required.
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Ok
19
Who else may have witnessed the incident or is aware of the situation?* This field is required.Please list anyone you know of who also witnessed the incident. Also, please list anyone who is aware of the incident from any other manner besides directly witnessing it. If you are not sure of who may have seen it or become aware of it, please enter "unknown" in the box. Please indicate if any of these are not affiliated with UMHB.
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20
Was the incident reported to campus authorities?* This field is required.
YESNO
21
Who was it reported to?* This field is required.Please describe who it was reported to, who made the report, and how it was reported. Additionally, please list if it was reported to anyone else.
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Ok
22
Please use this place to provide any other information you find important.
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