Report Well Being Concern or Aggressive/Threatening Behavior DRAFT

Tell Us About You

In this section, please tell us more about you and how to reach you.

Your full name:

Your position/title:

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Are you a student, instructor, staff member, parent, witness or other?

Your phone number:

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Enter your current phone #

Your email address:

Email address must be of a valid format.

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Use your Schoolcraft issued email address whenever possible

Your physical address:

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Include your street number, street name, apartment number, city, state, and zip code

Primary type of concern(Required):

This field is required.

Urgency of this report(Required):

This field is required.

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Use urgent for matters that are related to immediate concerns for health/safety

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

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Please choose the building or academic area where the incident occurred.

Specific location:

Tell Us About Others That Are Involved

List others involved in this incident or concern. For example, if you are concerned about a student in your class, please provide his/her name and other information. Use the "Add Another Person" button if you need to include witnesses or other parties.

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Summary of Concerns or Incident

Supporting Documentation

If you have supporting documentation but are unable to upload it when submitting the report, please let us know how/when you plan to submit it in the Summary Section of this report. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Report Well Being Concern or Aggressive/Threatening Behavior DRAFT - need other cond before launch

Tell Us About You

Tell Us About Others That Are Involved

Summary of Concerns or Incident

Supporting Documentation

Submission