Behavior Concern Report
Your Name:
Phone #:
Dept/College:
Your Supervisor:
Your Email:
Person of Concern:
Faculty
Staff
Student
Other
Describe behavior or situation:
What is your concern?
Identify other individuals, including their contact information and status as faculty, staff, students or other (if known):
Have you taken any actions?:
Yes
No
If "yes" describe:
Supervisor/Administrator Notified?
Yes
No
Name:
Witnesses:
Name:
Contact #:
Name:
Contact #:
Name:
Contact #:
Would you prefer to remain anonymous?
Yes
No
* Anonymity will be afforded if deemed appropriate for the situation reported
This form will be sent directly to the University Police Chief.