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Incident Reporting Form (Maxient)


If you need to report an emergency, do not use this form. Instead, dial 911.

Please use this form to provide detailed information regarding the incident you are reporting involving a Montana Western Student(s) or organization(s), whether these behaviors occur inside or outside of the classroom setting. Reportable behaviors may include Student Code of Conduct violations, a student who you feel may be struggling physically or psychologically, or any other behaviors of concern that you would like to see addressed or would like to discuss. This report will be reviewed, and the appropriate Code of Conduct violations will be assigned by a Montana Western Conduct administrator.

Once the report is received, a designated staff member will investigate the incident and address the issue reported. Please know that you, and the witness(es) in the report, may be contacted to provide further details, and you and the witness(es) may be needed in a possible conduct hearing at a later date.

Additionally, please note that a student's university conduct records are protected by a federal privacy law called the Family Educational Rights and Privacy Act (FERPA), therefore any information regarding the outcome of this report will not be shared with you without the consent of the student(s) involved.

This Incident report is ONLY to report Montana Western student related incidents. If you have any questions regarding filing this incident report, please contact the Dean of Students Office at (406)683-7388, Residence Life Office at (406)683-7565 or the Residence Life Contact Phone at (406)925-9828.

Background Information

 
Email address must be of a valid format.
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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 SID (Student ID #) if available.

Involved party 1

Questions

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Was Law Enforcement Notified?(Required)
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Was Residence Life Notified?(Required)
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Was the Dean of Students Office Notified?(Required)
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Was EMS Notified?(Required)
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Was Fire Notified?(Required)
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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