RC Cares Report Form

Background Information

If you wish to make an anonymous report to Care Team, we will evaluate the report and determine what follow up (if any) is necessary to address the concerns. We would encourage you, though, to submit your name and contact information to allow us to call or email should we have additional questions regarding your report.

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Your full name:

Your position/title:

Your email address:

Email address must be of a valid format.

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If you wish to receive a copy of this report, please include your email address.

Source of Information(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of concerning behavior:(Required):

This field is required.

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If an ongoing issue, use today's date.

Time (If applicable):

Location (If applicable)(Required):

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Where did the concerning behavior take place?

Involved Parties

Please list the individuals involved (excluding yourself) and provide information in as many of the listed demographic fields as you can provide, including student ID #, address, date of birth. If you do not have access to such demographic information, continue to submit the report and that information will be researched once the report is received.

Name

Gender

Role

Student ID Number

DOB (YYYY-MM-DD)

Housing Location

Concerning Behaviors

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

Background Information

Involved Parties

Concerning Behaviors

Supporting Documentation

Submission