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Incident Reporting Form

Please use this form to file a concern with the Office of Student Conduct, the Behavioral Intervention Team, or a report of hazing with the Columbus State Police Department. After a form has been submitted, the reporting party will be contacted, when possible, to discuss next steps which could include formal outreach and/or formal charges under the Student Code of Conduct. (If you have questions about this process prior to filing a concern, please contact the Office of Student Conduct at 614-287-2104.)

This single form can be used to report any of the following:

*Incidents of alleged hazing
*Concerning behavior for which intervention is requested
*Disruption of classroom or college activities
*Behavioral misconduct

If you need to document an academic integrity violation - please use the form found here.

In the narrative, please outline as much information about the concern as possible, including what happened, when and where the incident occurred, who was involved/has direct knowledge of the incident, the student(s) involved, how it came to your attention, and what steps have been taken thus far. (If you would like to submit an anonymous report, you may do so, but the college may be limited in the scope of the follow-up we can provide.) Please note that the information provided in the report may be seen by the individual of concern should formal charges of violating the Student Code of Conduct be alleged. As a result, we request that only objective and factual information be provided in the report. Please refrain from including subjective information.

Relevant materials that can be attached with this report may include written statements, photographs, police reports, and other records.

All information provided becomes an educational record and may be shared with the responding student if formal charges are filed, and may be used as documentation if the concern proceeds to a hearing. The confidentiality of educational records is outlined by the Federal Education Rights and Privacy Act (FERPA).

If you are considering filing a student concern related to sexual assault, sexual harassment, relationship violence or stalking, we encourage you to file a complaint here or you may contact Joan Cook, Title IX Coordinator, at jcook60@cscc.edu.

Background Information

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Your full name:

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Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Nature of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. Please enter the student(s) Cougar ID numbers, if available.

Name of Individual (or Organization)

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Questions

Please provide a detailed description of the incident/concern using concise, objective language. If the incident occurred in the classroom or as part of a course, please list the COURSE NAME. This field is required.

Was a report filed with the Police Department?(Required)

Yes No Not Sure

This field is required.

How would you prefer to receive follow-up?(Required) This field is required.

Supporting Documentation

Please attach a copy of syllabus statements; written statements; photographs; police reports; screenshots of social media posts, text messages, etc. When available, this information is helpful for effective follow up. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report