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General Non-Academic Incident Reporting Form

Incident Reporting Options
Report Concerning, Worrisome, or Threatening Behaviors
Faculty, staff, students, and community members are encouraged to use the CARE Report Form (Formerly BIT Report Form) to report behavior and hardships that they perceive with a student as concerning, worrisome, or threatening. For more information on what is meant by concerning or worrisome behavior, please visit the CARE Team page and review What to Watch For (Levels of Concern).

Report Relationship/Interpersonal Violence or Sexual Misconduct
Interpersonal violence includes dating violence, domestic violence, sexual harassment, sexual misconduct, or stalking behaviors. The Office of Title IX works to address interpersonal violence concerns. To report interpersonal violence, please use the Title IX Report Form.

Report an Incident that Occurred in an On-Campus Living Facility
To report non-academic violations that occur within an on-campus living facility, please use the Residence Life Incident Report Form. This will include violations of UT Tyler's alcohol/drug policy, disorderly conduct, and failure to comply within the residence hall/apartments.

Report an Academic Integrity Violation as a Faculty Member
Academic violations are behaviors that include, but not limited to, cheating or plagiarism. General classroom misbehavior is considered a non-academic violation. If you are a faculty member, you are to complete the Academic Dishonesty Form/Faculty Scholastic Dishonesty Form.

Report an Academic Integrity Violation as a Student
Academic violations are behaviors that include, but not limited to, cheating or plagiarism. General classroom misbehavior is considered a non-academic violation. If you are a student reporting another student, you are to complete the Academic Dishonesty Form/Student Scholastic Dishonesty Form.

Report a Grievance Against a Staff or Faculty Member
Students may present complaints and grievances concerning their treatment by an employee or department related to their status as a student. Grievances should identify the basis of the dispute, including specific facts, and provide relevant documents or any other information pertinent to the matter.

If none of the reports listed above fit your incident please fill out this General Incident Reporting Form below and answer as many questions as possible. Once you have submitted it, our department will route this information to the appropriate team of people to address this incident.

Resources
A PDF version of the resources provided to students by UT Tyler can be found here. For additional resources, please visit the Office of Student Conduct and Intervention link for university and community resources available to you. If you have any questions about what form to use when, please email the Dean of Students office or call 903.565.5946 during regular business hours.

Background Information

Your full name:

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.

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

Provide the names and ID numbers of all individuals involved in this incident and assign them a role.

The roles are as follows:
Alleged: Individual you believe to have violated a policy.
Victim: Individual you believe to have been harmed in this incident.
Witness: Individual you believe was present and/or knows about the incident but was not in violation of policies.
Student of concern: Individual whose behavior is odd and you have a concern for their well being.

If the student is not enrolled at The University of Texas at Tyler, please put their Driver's License Number in the ID Number field.

Name or Organization

Select Gender

Select Role

Student / EMPL ID

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

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.

Email me a copy of this report