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Incident Reporting Form

If this is a life-threatening emergency, please dial 9-1-1. If this is a situation of concern that requires immediate attention (example, a direct threat of harm to self and or others) please contact Campus Security at (425) 754-0154.

The Office of the Vice President of Student Engagement and Support at Edmonds College is charged with implementing and enforcing the Student Code of Conduct, which identifies behavioral expectations for all students. Please use this form if you have knowledge of an EC student violating the Student Code of Conduct, or representing a welfare/situation of concern (e.g., concerning behavior, homelessness, hunger, substance abuse, thoughts of suicide, mental health issues, etc.) This report may be routed to the college’s Care Team in an effort to address behavior that warrants concern for the safety of the college community and/or the safety of an individual as well as to seek out services and provide resources to ensure the health and wellness of those members of our campus community.

Please report any behaviors of concern involving Edmonds College students, whether these behaviors occur inside or outside of the classroom setting, or on or off-campus. Reportable behaviors may include Student Code of Conduct violations, general welfare concerns about a student, a student struggling physically or psychologically, or a student who is exhibiting any other concerning behavior that should be addressed as stated above. When completing this form, please include all the requested information as well as a detailed narrative of the incident you are reporting. If you have any questions regarding filing an incident report, please contact the Director of Student Conduct at (425) 640-1233.

To file a report regarding situations of Sexual Misconduct, Domestic Violence, or Stalking please do so here: Sexual Misconduct | Title IX Report. All sexual misconduct reports will be routed directly to the College's Title IX Coordinator.

Information provided here is a public record and could be disclosed if requested pursuant to the Public Records Act, Chapter 42.56 RCW.

Background Information

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Your full name:

Your position/title:

Your preferred phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Urgency 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 list an SSN or Drivers License number in the block labeled ctcLink# if available.

Name

Select Gender

Select Role

ctcLink # (If known, no dashes)

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Supporting Documentation

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