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Incident Reporting Form

This form may be used by any member of the Connecticut College community to report concerning behavior by a student or document a violation of the Honor Code and/or Student Code of Conduct. Please know anonymous reports may limit our ability to respond.

Forms are submitted to the Office of the Dean of Students. If you have any questions, please contact the Senior Associate Dean of Student Life, Sarah Cardwell.

Background Information

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Your full name:

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Or, you may write Anonymous

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

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 leave the identification number blank.

Involved party 1

Name or Organization

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Hall/Address

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).(Required) This field is required.

Did this situation involve any of the following (check all that apply)?(Required)

Alcohol ER Transport Drugs Harassment Stalking Sexual Misconduct None of the above

You must make at least one selection.

Did Campus Safety respond or were they involved in this incident?(Required)

Yes No

This field is required.

Did the police respond or were they involved in this incident?(Required)

Yes No

This field is required.

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.

Background Information

Involved Parties

Questions

Supporting Documentation

Submission