Incident Report

A person who has experienced a violation of the policy has the right to report that conduct 24 hours a day 7 days a week, and in most cases the right to request that an investigation stop at any point. Florida College will provide supportive measures to all parties from the beginning through the resolution of a reported incident.

Report Type Options

Report to Title IX Coordinator

Your report will confidentially go directly to the Title IX Coordinator. The Title IX Coordinator is obligated to follow up on the information provided.

Report to Confidential Support

Your report will confidentially go to the On-Campus Confidential Support Representative. The representative is prohibited from revealing information to any other person except in very specific situations.

Individuals wishing to remain anonymous may choose not to include their personal information, except for employees reporting an incident involving a student. However, anonymous reports often limit the ability of the College to respond to a report.

Report Type(Required)

Confidential Support(Required)

Please select who you would like to be the confidential support.

Your report will confidentially go directly to the Title IX Coordinator. The Title IX Coordinator is obligated to follow up on the information provided.

Your report will confidentially go to the On-Campus Confidential Support Representative. The representative is prohibited from revealing information to any other person unless:

given express permission by the person who disclosed the information,
there is an imminent threat of harm to self or others,
the suspected violation involves abuse of a minor under the age of 18, or
as otherwise permitted by law or court order.

Are you an employee of Florida College?(Required)

Yes

Does This Incident Involve a Student?(Required)

Yes

Employees are required to include their personal information if the incident involves a student.

Personal Information

Name

First Last

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Employee Information

Name(Required)

First Last

Phone(Required)

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Incident Information

Nature of This Report(Required)

Date of the Incident(Required)

Time of the Incident(Required)

Location of the Incident(Required)

Involved Parties

Please list information about all parties involved in this incident/concern.

How Many Involved Parties?

Involved Party Name

First Last

Involved Party Role

Involved Party Phone

Involved Party Name 2

First Last

Involved Party Role 2

Involved Party Phone 2

Involved Party Name 3

First Last

Involved Party Role 3

Involved Party Phone 3

Involved Party Name 4

First Last

Involved Party Role 4

Involved Party Phone 4

Involved Party Name 5

First Last

Involved Party Role 5

Involved Party Phone 5

Description of the Incident/Concern(Required)

Use specific, concise language.

Did the Police Respond?(Required)

Yes

Other Agencies Involved

Please list any other agencies or department present.

Supporting Documentation

Use this area to send photos, videos, emails, texts, or other supporting documents.

Drop files here or

Max. file size: 100 MB.