CFCC Student Incident/Title IX Reporting Form

This Incident Reporting Form is not for Emergency Services. 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), harassment, discrimination, sexual misconduct, violation of the CFCC Code of Conduct, and/or file a complaint or grievance.

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 contacting the complainant (reporting party), respondent (responding party), 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 the victim, you may choose to identify yourself, or not (anonymous), to ensure confidentiality. If you are a third-party complainant who is not the victim, please include the victim’s identifiable information, only if the victim wishes. Victims completing this form who provide personally identifiable information can expect the college to follow up with an appropriate investigation.

Background Information

Your Full Name

First Last

Your Position/Title

Your Phone Number

Your Email Address

Your Physical Address

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

Nature of this Report(Required)

Time of Incident

Location of Incident(Required)

Specific Location

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.

Name or Organization

Select Gender

Select Role

ID Number

Date

Phone Number

Address

Questions

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).

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

Yes

I don't know

If you responded in the affirmative ("Yes") to the question above and are aware of the agency and/or a report number, please include it here:

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below.

Max. file size: 64 MB.

CFCC Student Incident/Title IX Reporting Form

Background Information

Involved Parties

Questions

Supporting Documentation

(910) 362-7000

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