Red Flag Incident Reporting Form

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Background Information

Your full name: Or, you may write Anonymous
Your phone number: - -
Your email address:
Your physical address:
* Type of report:
Urgency of this report:
* Date of incident: / /
  must be formatted MM-DD-YYYY
Time of incident: :
* Location of incident:
Specific location:

Reason(s) for Report

Please indicate the relevant category(s) that pertain to this incident report. Indicating values in this box does not mean a student will be found responsible for a violation.

Category of Concern

 Alarming References to Guns, Ammunition, Bombs Behavior Pushes the Limits and Interferes with Class Change in Demeanor Depressed, Persistent Sadness, or Unexplained Crying Destructive, Harmful, or Threatening Behaviors Disruptive Classroom Behavior Disturbing Written Material or Class Discussion Drastic Change in Appearance Drastic Change in Dress/Grooming General Concern (describe below) Highly Disturbed Behavior Irrational Feelings of Persecution Other (describe below) Outbursts of Anger Suicidal Remarks or Attempts Unusual or Exaggerated Emotional Response


Student Code of Conduct/Academic

 Alcohol - Consumption/Possession Apprehension of Harm Behavior Disrupts Class Bullying Buying, Selling, Stealing or Soliciting Examination Content Cheating on Examination Collusion on Assignments Submitted for Credit Controlled Substance - Possession/Distribution Controlled Substance - Use/Possession Destroying Property Disrepectful to College Authority Dress/Grooming False Information False Report Falsifying Student Records Forgery Freedom of Expression Inappropriate Computer Use Interfering with College Activities Noncompliance with College Officials Physical Harm Plagiarism Sexual Harassment Testing Center Irregularity Theft Unauthorized Presence Unauthorized Use of Computer Hardware/Software Violating Disciplinary Sanctions Violation of College Policies Weapon

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.

/ /   - -    

Description / Narrative

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).

Additional Questions

* Was Campus Security contacted?

 Yes No

* Was Law Enforcement (i.e., Sheriff, Police, etc.) contacted?

 Yes No

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. Maximum 12MB total
Attachments require time to upload, so please be patient after you click to submit this report.

One last step...

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