First Name
Middle Initial
Last Name
Email
Your Role
Phone Number
* Date of Concerning Behavior
Time of Concerning Behavior
* Location of Incident
Specific Location or Room Number of Incident
Involved Parties
Please list as much of the following information for each individual involved as you know or are able to recall.
Individual 1 Name
Individual 1 ID Number
Individual 1 Gender
Individual 1 Date of Birth
Individual 1 Phone Number
Individual 1 Email Address
Individual 1 Involvement Role
Individual 2 Name
Individual 2 ID Number
Individual 2 Gender
Individual 2 Date of Birth
Individual 2 Phone Number
Individual 2 Email Address
Individual 2 Involvement Role
Individual 3 Name
Individual 3 ID Number
Individual 3 Gender
Individual 3 Date of Birth
Individual 3 Phone Number
Individual 3 Email Address
Individual 3 Involvement Role
Reason(s) for Report
* PLEASE PROVIDE A DETAILED DESCRIPTION OF THE INCIDENT OR CONCERN USING SPECIFIC, CONCISE, OBJECTIVE LANGUAGE. (PLEASE BE PROFESSIONAL, ACCURATE AND FACTUAL. RECITATIONS OF OBSERVATIONS AND FACTS ARE MORE USEFUL THAN CHARACTERIZATIONS OR LABELS.)
Check all that apply
Behaviors of Concern
Criminal Behavior
Student Code of Conduct
Information Report
Harassment/Discrimination
HOW WOULD YOU LIKE US TO FOLLOW UP WITH YOU?
SUPPORTING DOCUMENTATION
PHOTOS, PHOTOS, VIDEO, EMAIL, AND OTHER SUPPORTING DOCUMENTS MAY BE ATTACHED BELOW.Add one file per "Choose a file" button. You may add up to 6 files, if needed.
Please call campus security at (605)367-7847 or call 911.
Building Addresses/Points of Contact
Mickelson Center2320 N Career Ave. Sioux Falls, SD 57107
Health Center2300 N Career Ave. Sioux Falls, SD 57107
Technology Center2205 N Career Ave. Sioux Falls, SD 57107
This is just a space holder!
Wood Center2000 N Career Ave. Sioux Falls, SD 57107
HUB2001 N Career Ave. Sioux Falls, SD 57107
* Is there a reason to believe that there is an immediate threat or danger to individual or member of the campus community?