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Student of Concern Report


THIS REPORT IS FOR NON-CRITICAL OR NON-URGENT REPORTING OF CONCERNING STUDENT BEHAVIOR

 

To report emergency situations occurring on or off the NIU DeKalb Campus, contact the Police at 911.

 

This form is for reporting any student who is displaying concerning behaviors that may impact their ability to be safe and or successful, whether it has occurred on or off campus. This form is routed to the Division of Student Affairs. Completing this form does not constitute filing a police report, nor does this report serve as official notice to Student Conduct. Information contained in the report is private but may be shared as appropriate under federal and state mandates. To file a police report contact the NIU Police at 815-753-1212 or the appropriate local police department.

For the "Involved Parties" section of the report, please include as much information as possible. The following definitions are applicable on this form:

  • Student-a person who is currently registered for classes

 

  • Non-student-a person who is not currently registered for classes

 

  • Student Organization-a recognized student organization, on file with the Student Association

 

  • Staff-a person who has an administrative role at the institution, and does not teach classes

 

  • Faculty-a person who teaches classes

 

  • Student of Concern-any student who is displaying behaviors that may impace the student's ability to be successful or safe

 

  • Other Involved-a person who is involved in an incident and does not fit the description of any other involved party

 

Background Information

Please complete the information in the following section

 
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If there are multiple incidents, please indicate the most recent date or approximate date.
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Time value must be standardized and entered in the following format (9:00 AM or 9:00 PM)
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Involved Parties

Please complete as much information as known to the reporter.
For NIU Directory Information, click here.

Involved party 1

Questions

Please answer these questions as completely as possible

What is the relationship between the reporter and the student of concern? (Select all that apply)(Required)
You must make at least one selection.
Did you observe the concerning behavior you are reporting?(Required)
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Did you speak directly with the student about your concern?(Required)
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Did you refer the student to any services?(Required)
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Please identify the resources that you specifically referred the student to:(Required)
You must make at least one selection.
Do you want any follow up regarding this report?(Required)
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Is this report the re-submission of a previously submitted incident report? (This is designed to replace the information on a previously submitted report.)(Required)
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Is this report being submitted, in follow up to a previously submitted Student of Concern report? (The information contained in this report is designed to add additional information to a previously submitted report.)(Required)
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Supporting Documentation

If you wish to include any files which you believe may be helpful to university staff responding to this incident, please upload them below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Submission