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Student of Concern Reporting Form


If this is an emergency, please call 911 or Campus Security at 307-268-2688.

If you have a concern about a Casper College student, you are encouraged to notify the CC Care Team using the Incident Report Form below. If you have any questions regarding filing an incident report, please contact the Chair of the CC Care Team and Dean of Students, Corey Peacock, at 307-268-2249 or corey.peacock@caspercollege.edu.

When completing this form, please include your name, title, and contact information and provide as much detailed information regarding the incident as possible. Although anonymous reports may be submitted, we encourage you to include your contact information so that we may follow up with you for any further information or clarification that may be necessary.

Once an Incident Report has been received by the CC Care Team, it will be reviewed by a team member, who will take appropriate action, which may or may not include contacting the student, you, and any witnesses you have identified. Casper College disciplinary records are protected by a federal privacy law called the Family Educational Rights and Privacy Act. This form may also be used for reports involving Casper College staff or faculty members.

Background Information

 
Email address must be of a valid format.
This field is required.
This field is required.

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, if available, please list a social security number or drivers license number in the block labeled SID.

Involved party 1

Questions

This field is required.
Choose any items from the following list that apply.
You must make at least one selection.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission