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CFCC Student Incident Reporting Form

This Incident Reporting Form is not for emergency purposes. Please do not use this site to report events presenting an immediate threat to life, health, property, or the environment. If you have an emergency and/or require emergency assistance, please dial 911.

This form is designed to provide CFCC students, employees, or guests with an online method to report specific information related to an alleged incident(s), including but not limited to discrimination on the basis of sex, sexual harassment, sexual assault, stalking, dating or domestic violence, violation of the CFCC Code of Conduct, and/or to file a complaint or grievance.

Furthermore, the Dean of Student Affairs serves as CFCC’s Title IX Coordinator and has primary responsibility for coordinating the College’s efforts to comply with and carry out its responsibilities under Title IX, which prohibits sex discrimination in all the operations of the College, as well as any other protected status and retaliation for the purpose of interfering with any right or privilege of an individual. The Title IX Coordinator will determine whether the alleged conduct, as described by the reporting party, falls within the scope of the CFCC Title IX policy, and ultimately, whether it would constitute a Title IX violation. For all other complaints of discrimination or harassment that do not meet the definition of Sexual Harassment under Title IX, and likewise prohibited, shall be governed under and construed in accordance with the CFCC Employee Handbook or the CFCC Student Code of Conduct.

Due to the specific needs of this reporting form, you are asked to complete the entire form in order for the complaint/inquiry to be submitted. CFCC will use the information provided to begin an informal investigation, which may include involved parties and/or any potential witnesses. However, if the report does not contain specific information needed, the College’s investigation and response may be limited due to insufficient information. Prior to completing this form please review the Cape Fear Community College Code of Conduct Policies and Procedures in the student handbook on the CFCC website at cfcc.edu/catalog/ .

* If the person completing this form is a victim/survivor, you may choose to be anonymous, to ensure confidentiality and safety.

Background Information

Your Full Name
Your Physical Address
Nature of this Report (Code of Conduct)
Choose all that apply.
Nature of this Report (Title IX)
Choose all that apply.
Time of Incident
:

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 the SSN or Drivers License number if available in the block labeled SID (Student ID #) if available.
MM slash DD slash YYYY

Questions

Did a Law Enforcement agency respond (i.e., NHC Sheriff Deputy, Wilmington Police Dept., and/or Campus Security)?(Required)

Supporting Documentation

Max. file size: 64 MB.

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