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Incident Reporting Form



If violence is occurring “right now” and you need immediate help, call Campus Police at ext. 4300.

Thank you for letting us know that you are concerned about a student. This referral will be reviewed within one business day and you may be contacted to provide additional information. If you have a concern about a student that you believe requires immediate attention, please contact Campus Police at 310-434-4300. Please note that these referrals are not monitored 24/7 and should not be used in the case of an emergency or if there is a threat to the safety and/or life.

This is a combined reporting form to report issues to the Campus Disciplinarian, Care and Prevention Team, or Title IX Coordinator. Please specify this in "Nature of Concern" on the drop down menu of the form below.

The CPT cares about students and their basic needs and recognize the need is tremendous right now. In effort to get resources to students quickly, please share this link with your students so they can access local food, housing and financial resources: www.smc.edu/news/coronavirus/resources/index.php

    • If your principal concern is to bring concerning or threatening behavior to the attention of the Care and Prevention Team, please select "Report Concerns to Care and Prevention Team" under "Nature of the Report."

 

    • If your principal concern is a Title IX report, please select "Title IX Report" (examples include sexual misconduct, sexual assault, stalking, etc..) under "Nature of the Report."

 

    • If your principal concern is disciplinary violations, please select "Disciplinary Conduct Report" under "Nature of the Report."

 

  • If your principal concern is academic dishonesty, please select "Academic Dishonesty" under "Nature of the Report."

 

Please do not be concerned about selecting the wrong category. Your information will go to the appropriate College official to respond to your concerns.

Please use your College email address. It is important that we have your full name, telephone number, the Student ID number when available, and the class and section number.

Background Information

 
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Or, you may write Anonymous
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Use the best number to reach you.
Email address must be of a valid format.
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***For SMC employees*** use your SMC email ONLY!!!
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For Basic Needs see link in Instructions above
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If you are a student or non-campus party please select OTHER
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Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide.

Involved party 1

INFORMATION RELATING TO INCIDENT OR CONCERN

This section was modified on April 17, 2020, to improve ease of use. Please review the new information above concerning basic needs.

Please check all that apply:(Required)
You must make at least one selection.
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Does the student know you are submitting this referral?(Required)
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Has Campus Police been notified of this incident?(Required)
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***Supporting Documentation - PDF format ONLY***

Please submit documentation in PDF format only. NO jpg's please Do not put an "S" in front of the student's ID number. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission