{"id":151,"date":"2026-07-24T13:36:48","date_gmt":"2026-07-24T17:36:48","guid":{"rendered":"https:\/\/cfcc.edu\/office-of-student-affairs\/?page_id=151"},"modified":"2026-07-24T13:36:48","modified_gmt":"2026-07-24T17:36:48","slug":"incident-reporting-form","status":"publish","type":"page","link":"https:\/\/cfcc.edu\/office-of-student-affairs\/incident-reporting-form\/","title":{"rendered":"Incident Reporting Form"},"content":{"rendered":"<p><strong>This form is not for emergencies.<\/strong> Do not use this form to report situations posing an immediate threat to life, health, property, or the environment. If you have an emergency or need immediate assistance, call <strong>911<\/strong>.<\/p>\n<p>This form may be used by CFCC students, employees, and guests to report alleged incidents, including discrimination based on sex, sexual harassment, sexual assault, stalking, dating or domestic violence, violations of the CFCC Code of Conduct, or to file a complaint or grievance.<\/p>\n<p>The Dean of Student Affairs serves as CFCC&#8217;s Title IX Coordinator and oversees the College&#8217;s compliance with Title IX. The Title IX Coordinator will determine whether the reported conduct falls within the College&#8217;s Title IX Policy. Reports that do not meet the definition of Title IX Sexual Harassment will be addressed under the applicable provisions of the CFCC Employee Handbook or Student Code of Conduct.<\/p>\n<p>CFCC will use the information provided to conduct an initial assessment and determine appropriate next steps, which may include contacting the reporting party, involved individuals, and potential witnesses.<\/p>\n<p>You may submit this report anonymously. However, providing your contact information and as much detail as possible will help the College assess the report, investigate when appropriate, and respond effectively. Reports submitted anonymously or with limited information may restrict the College&#8217;s ability to investigate or take appropriate action.<\/p>\n<script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script> <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_3' style='display:none'> <form method='post' enctype='multipart\/form-data'  id='gform_3'  action='\/office-of-student-affairs\/wp-json\/wp\/v2\/pages\/151' data-formid='3' novalidate> <div class='gform-body gform_body'>  <div id='gform_fields_3' class='gform_fields top_label form_sublabel_below description_below'>  <div id=\"field_3_4\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_4\"> <label class='gfield_label gform-field-label' for='input_3_4' >CFCC Affiliation of the Individual Being Reported<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label> <div class='ginput_container ginput_container_select'> <select name='input_4' id='input_3_4' class='small gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Employee' >Employee<\/option><option value='Student' >Student<\/option><option value='Visitor\/Other\/Unsure' >Visitor\/Other\/Unsure<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_64\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_64\"> &nbsp; <\/div>  <div id=\"field_3_5\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_5\"> <h3 class=\"gsection_title\">Reporting Person&#039;s Information<\/h3> <div class='gsection_description' id='gfield_description_3_5'> The following questions are about you, the person filling out this form. <\/div>  <\/div> <fieldset id=\"field_3_1\"  class=\"gfield gfield--type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_1\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Your Name<\/legend> <div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_3_1'> <span id='input_3_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_3_1_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_3_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_3_1_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_3_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span> <\/div> <\/fieldset> <div id=\"field_3_6\"  class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_6\"> <label class='gfield_label gform-field-label' for='input_3_6' >Your Position\/Title (if you are a CFCC employee)<\/label> <div class='ginput_container ginput_container_text'> <input name='input_6' id='input_3_6' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_7\"  class=\"gfield gfield--type-phone gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_7\"> <label class='gfield_label gform-field-label' for='input_3_7' >Your Phone Number<\/label> <div class='ginput_container ginput_container_phone'> <input name='input_7' id='input_3_7' type='tel' value='' class='large'    aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_8\"  class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_8\"> <label class='gfield_label gform-field-label' for='input_3_8' >Your Email Address<\/label> <div class='ginput_container ginput_container_email'> <input name='input_8' id='input_3_8' type='email' value='' class='large'     aria-invalid=\"false\"  \/> <\/div>  <\/div>  <div id=\"field_3_60\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_60\"> &nbsp; <\/div>  <div id=\"field_3_59\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_59\"> <h3 class=\"gsection_title\">Person(s) Being Reported, if different from above<\/h3> <\/div> <fieldset id=\"field_3_56\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_56\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Personal information<\/legend> <div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'>  <div class='gfield_list gfield_list_container'>  <div class=\"gfield_list_header gform-grid-row\">  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Name <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Position\/Title <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Student ID <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Birthdate <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Phone <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Email <\/div>  <div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\"> &nbsp; <\/div>  <\/div>  <div class=\"gfield_list_groups\">  <div class='gfield_list_row_odd gfield_list_group gform-grid-row'>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell1 gform-grid-col' data-label='Name'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell2 gform-grid-col' data-label='Position\/Title'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Position\/Title, Row 1' data-aria-label-template='Position\/Title, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell3 gform-grid-col' data-label='Student ID'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Student ID, Row 1' data-aria-label-template='Student ID, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell4 gform-grid-col' data-label='Birthdate'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Birthdate, Row 1' data-aria-label-template='Birthdate, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell5 gform-grid-col' data-label='Phone'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Phone, Row 1' data-aria-label-template='Phone, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_56_cell6 gform-grid-col' data-label='Email'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_56\" aria-label='Email, Row 1' data-aria-label-template='Email, Row {0}' type='text' name='input_56[]' value=''   \/> <\/div>  <div class='gfield_list_icons gform-grid-col'> <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button> <\/div>  <\/div>  <\/div>  <\/div>  <\/div>  <div class='gfield_description' id='gfield_description_3_56'> Use the plus symbol at the end of the row to add another person, if needed. <\/div> <\/fieldset> <div id=\"field_3_61\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_61\"> &nbsp; <\/div>  <div id=\"field_3_19\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_19\"> <h3 class=\"gsection_title\">Incident Information<\/h3> <\/div> <fieldset id=\"field_3_18\"  class=\"gfield gfield--type-list gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_18\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Witnesses, if applicable<\/legend> <div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'>  <div class='gfield_list gfield_list_container'>  <div class=\"gfield_list_header gform-grid-row\">  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Name <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Position\/Title <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Student ID <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Birthdate <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Phone <\/div>  <div class=\"gform-field-label gfield_header_item gform-grid-col\"> Email <\/div>  <div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\"> &nbsp; <\/div>  <\/div>  <div class=\"gfield_list_groups\">  <div class='gfield_list_row_odd gfield_list_group gform-grid-row'>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell1 gform-grid-col' data-label='Name'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Name, Row 1' data-aria-label-template='Name, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell2 gform-grid-col' data-label='Position\/Title'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Position\/Title, Row 1' data-aria-label-template='Position\/Title, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell3 gform-grid-col' data-label='Student ID'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Student ID, Row 1' data-aria-label-template='Student ID, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell4 gform-grid-col' data-label='Birthdate'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Birthdate, Row 1' data-aria-label-template='Birthdate, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell5 gform-grid-col' data-label='Phone'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Phone, Row 1' data-aria-label-template='Phone, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_group_item gfield_list_cell gfield_list_18_cell6 gform-grid-col' data-label='Email'> <input aria-invalid='false'  aria-describedby=\"gfield_description_3_18\" aria-label='Email, Row 1' data-aria-label-template='Email, Row {0}' type='text' name='input_18[]' value=''   \/> <\/div>  <div class='gfield_list_icons gform-grid-col'> <button type=\"button\"  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type=\"button\"  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button> <\/div>  <\/div>  <\/div>  <\/div>  <\/div>  <div class='gfield_description' id='gfield_description_3_18'> Use the plus symbol at the end of the row to add another person, if needed. <\/div> <\/fieldset> <div id=\"field_3_20\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_20\"> <label class='gfield_label gform-field-label' for='input_3_20' >Date of incident<\/label> <div class='ginput_container ginput_container_date'> <input name='input_20' id='input_3_20' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_3_20_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_3_20_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span> <\/div> <input type='hidden' id='gforms_calendar_icon_input_3_20' class='gform_hidden' value='https:\/\/cfcc.edu\/office-of-student-affairs\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/> <\/div> <fieldset id=\"field_3_21\"  class=\"gfield gfield--type-time gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_21\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Time of incident<\/legend> <div class=\"ginput_container ginput_complex gform-grid-row\">  <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_3_21'> <input type='number' maxlength='2' name='input_21[]' id='input_3_21_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='false'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_3_21_1'>Hours<\/label> <\/div>  <div class=\"below hour_minute_colon gform-grid-col\"> : <\/div>  <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'> <input type='number' maxlength='2' name='input_21[]' id='input_3_21_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='false'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_3_21_2'>Minutes<\/label> <\/div>  <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' > <select name='input_21[]' id='input_3_21_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_3_21_3'>AM\/PM<\/label> <\/div>  <\/div> <\/fieldset> <div id=\"field_3_23\"  class=\"gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_23\"> <label class='gfield_label gform-field-label' for='input_3_23' >Location of Incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label> <div class='ginput_container ginput_container_select'> <select name='input_23' id='input_3_23' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='On Campus' >On Campus<\/option><option value='Online\/Virtual' >Online\/Virtual<\/option><option value='Off Campus' >Off Campus<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_24\"  class=\"gfield gfield--type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_24\"> <label class='gfield_label gform-field-label' for='input_3_24' >Campus<\/label> <div class='ginput_container ginput_container_select'> <select name='input_24' id='input_3_24' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Wilmington Campus (Downtown)' >Wilmington Campus (Downtown)<\/option><option value='North Campus' >North Campus<\/option><option value='Surf City' >Surf City<\/option><option value='Burgaw Center' >Burgaw Center<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_25\"  class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_25\"> <label class='gfield_label gform-field-label' for='input_3_25' >Building\/Room\/Area<\/label> <div class='ginput_container ginput_container_text'> <input name='input_25' id='input_3_25' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_62\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_62\"> &nbsp; <\/div>  <div id=\"field_3_26\"  class=\"gfield gfield--type-select gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_26\"> <label class='gfield_label gform-field-label' for='input_3_26' >Report Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label> <div class='ginput_container ginput_container_select'> <select name='input_26' id='input_3_26' class='large gfield_select'  aria-describedby=\"gfield_description_3_26\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Accessibility and ADA Concern (reporting accessibility concerns or barriers, not for requesting accommodations)' >Accessibility and ADA Concern (reporting accessibility concerns or barriers, not for requesting accommodations)<\/option><option value='Accident, Injury, or Fall' >Accident, Injury, or Fall<\/option><option value='Conduct and Policy Violations' >Conduct and Policy Violations<\/option><option value='Title IX Sex-Based Discrimination &amp; Harassment' >Title IX: Sex-Based Discrimination &amp; Harassment<\/option><\/select> <\/div>  <div class='gfield_description' id='gfield_description_3_26'> Additional questions will appear based on the type chosen <\/div>  <\/div>  <div id=\"field_3_57\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_57\"> <h3 class=\"gsection_title\"><\/h3> <\/div> <fieldset id=\"field_3_58\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_58\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Select all that apply<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_3_58'>  <div class='gchoice gchoice_3_58_1'> <input class='gfield-choice-input' name='input_58.1' type='checkbox'  value='Pathways and Obstructions - e.g. blocked or steep ramps, narrow doorways, broken elevators, uneven walkways'  id='choice_3_58_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_1' id='label_3_58_1' class='gform-field-label gform-field-label--type-inline'>Pathways and Obstructions - e.g. blocked or steep ramps, narrow doorways, broken elevators, uneven walkways<\/label> <\/div>  <div class='gchoice gchoice_3_58_2'> <input class='gfield-choice-input' name='input_58.2' type='checkbox'  value='Buildings and Restrooms - e.g. inaccessible stalls, heavy doors, missing grab bars or handrails'  id='choice_3_58_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_2' id='label_3_58_2' class='gform-field-label gform-field-label--type-inline'>Buildings and Restrooms - e.g. inaccessible stalls, heavy doors, missing grab bars or handrails<\/label> <\/div>  <div class='gchoice gchoice_3_58_3'> <input class='gfield-choice-input' name='input_58.3' type='checkbox'  value='Signage - e.g. missing signs, signs at incorrect heights or locations, signs without tactile design'  id='choice_3_58_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_3' id='label_3_58_3' class='gform-field-label gform-field-label--type-inline'>Signage - e.g. missing signs, signs at incorrect heights or locations, signs without tactile design<\/label> <\/div>  <div class='gchoice gchoice_3_58_4'> <input class='gfield-choice-input' name='input_58.4' type='checkbox'  value='Parking and Exterior - e.g. inadequate accessible parking, missing curb cuts, improper signage'  id='choice_3_58_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_4' id='label_3_58_4' class='gform-field-label gform-field-label--type-inline'>Parking and Exterior - e.g. inadequate accessible parking, missing curb cuts, improper signage<\/label> <\/div>  <div class='gchoice gchoice_3_58_5'> <input class='gfield-choice-input' name='input_58.5' type='checkbox'  value='Website Barriers - e.g. missing alt text, lack of keyboard navigation, poor color contrast, lack of closed captioning'  id='choice_3_58_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_5' id='label_3_58_5' class='gform-field-label gform-field-label--type-inline'>Website Barriers - e.g. missing alt text, lack of keyboard navigation, poor color contrast, lack of closed captioning<\/label> <\/div>  <div class='gchoice gchoice_3_58_6'> <input class='gfield-choice-input' name='input_58.6' type='checkbox'  value='Auxiliary Aids - e.g. lack of sign language interpreters, assistive listening devices, or alternative format materials'  id='choice_3_58_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_6' id='label_3_58_6' class='gform-field-label gform-field-label--type-inline'>Auxiliary Aids - e.g. lack of sign language interpreters, assistive listening devices, or alternative format materials<\/label> <\/div>  <div class='gchoice gchoice_3_58_7'> <input class='gfield-choice-input' name='input_58.7' type='checkbox'  value='Policy and Service - e.g. service animal restrictions, refusal of reasonable program modifications'  id='choice_3_58_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_58_7' id='label_3_58_7' class='gform-field-label gform-field-label--type-inline'>Policy and Service - e.g. service animal restrictions, refusal of reasonable program modifications<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_27\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_27\"> <h3 class=\"gsection_title\">Accident, Injury, or Fall details<\/h3> <\/div> <fieldset id=\"field_3_43\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_43\"><legend class='gfield_label gform-field-label'  >Did the injured party seek or receive medical care?<\/legend> <div class='ginput_container ginput_container_radio'>  <div class='gfield_radio' id='input_3_43'>  <div class='gchoice gchoice_3_43_0'> <input class='gfield-choice-input' name='input_43' type='radio' value='Yes'  id='choice_3_43_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_43_0' id='label_3_43_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label> <\/div>  <div class='gchoice gchoice_3_43_1'> <input class='gfield-choice-input' name='input_43' type='radio' value='No'  id='choice_3_43_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_43_1' id='label_3_43_1' class='gform-field-label gform-field-label--type-inline'>No<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_29\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_29\"> <label class='gfield_label gform-field-label' for='input_3_29' >Name of physician\/hospital<\/label> <div class='ginput_container ginput_container_text'> <input name='input_29' id='input_3_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_30\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_30\"> <label class='gfield_label gform-field-label' for='input_3_30' >Was the individual carrying anything? If so, describe.<\/label> <div class='ginput_container ginput_container_text'> <input name='input_30' id='input_3_30' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_31\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_31\"> <label class='gfield_label gform-field-label' for='input_3_31' >Type of footwear worn by the injured individual<\/label> <div class='ginput_container ginput_container_text'> <input name='input_31' id='input_3_31' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_34\"  class=\"gfield gfield--type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_34\"> <label class='gfield_label gform-field-label' for='input_3_34' >Did the incident happen inside or outside?<\/label> <div class='ginput_container ginput_container_select'> <select name='input_34' id='input_3_34' class='small gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Inside' >Inside<\/option><option value='Outside' >Outside<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_32\"  class=\"gfield gfield--type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_32\"> <label class='gfield_label gform-field-label' for='input_3_32' >Weather<\/label> <div class='ginput_container ginput_container_select'> <select name='input_32' id='input_3_32' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Clear' >Clear<\/option><option value='Rain' >Rain<\/option><option value='Snow' >Snow<\/option><option value='Sleet' >Sleet<\/option><option value='Fog' >Fog<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_33\"  class=\"gfield gfield--type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_33\"> <label class='gfield_label gform-field-label' for='input_3_33' >Visibility<\/label> <div class='ginput_container ginput_container_select'> <select name='input_33' id='input_3_33' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Excellent' >Excellent<\/option><option value='Good' >Good<\/option><option value='Fair' >Fair<\/option><option value='Poor' >Poor<\/option><\/select> <\/div>  <\/div>  <div id=\"field_3_37\"  class=\"gfield gfield--type-select gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_37\"> <label class='gfield_label gform-field-label' for='input_3_37' >Type of Surface<\/label> <div class='ginput_container ginput_container_select'> <select name='input_37' id='input_3_37' class='large gfield_select'     aria-invalid=\"false\" ><option value='' ><\/option><option value='Paved' >Paved<\/option><option value='Concrete' >Concrete<\/option><option value='Gravel' >Gravel<\/option><option value='Dirt' >Dirt<\/option><option value='Lawn' >Lawn<\/option><option value='Wood' >Wood<\/option><option value='Tile' >Tile<\/option><option value='Carpet' >Carpet<\/option><\/select> <\/div>  <\/div> <fieldset id=\"field_3_40\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_40\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Condition of Surface<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_3_40'>  <div class='gchoice gchoice_3_40_1'> <input class='gfield-choice-input' name='input_40.1' type='checkbox'  value='Clear'  id='choice_3_40_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_1' id='label_3_40_1' class='gform-field-label gform-field-label--type-inline'>Clear<\/label> <\/div>  <div class='gchoice gchoice_3_40_2'> <input class='gfield-choice-input' name='input_40.2' type='checkbox'  value='Dry'  id='choice_3_40_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_2' id='label_3_40_2' class='gform-field-label gform-field-label--type-inline'>Dry<\/label> <\/div>  <div class='gchoice gchoice_3_40_3'> <input class='gfield-choice-input' name='input_40.3' type='checkbox'  value='Wet'  id='choice_3_40_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_3' id='label_3_40_3' class='gform-field-label gform-field-label--type-inline'>Wet<\/label> <\/div>  <div class='gchoice gchoice_3_40_4'> <input class='gfield-choice-input' name='input_40.4' type='checkbox'  value='Snow'  id='choice_3_40_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_4' id='label_3_40_4' class='gform-field-label gform-field-label--type-inline'>Snow<\/label> <\/div>  <div class='gchoice gchoice_3_40_5'> <input class='gfield-choice-input' name='input_40.5' type='checkbox'  value='Icy'  id='choice_3_40_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_5' id='label_3_40_5' class='gform-field-label gform-field-label--type-inline'>Icy<\/label> <\/div>  <div class='gchoice gchoice_3_40_6'> <input class='gfield-choice-input' name='input_40.6' type='checkbox'  value='Uneven'  id='choice_3_40_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_6' id='label_3_40_6' class='gform-field-label gform-field-label--type-inline'>Uneven<\/label> <\/div>  <div class='gchoice gchoice_3_40_7'> <input class='gfield-choice-input' name='input_40.7' type='checkbox'  value='Even'  id='choice_3_40_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_40_7' id='label_3_40_7' class='gform-field-label gform-field-label--type-inline'>Even<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_41\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_41\"> <label class='gfield_label gform-field-label' for='input_3_41' >Other contributing factors if any<\/label> <div class='ginput_container ginput_container_text'> <input name='input_41' id='input_3_41' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_3_42\"  class=\"gfield gfield--type-fileupload field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_42\"> <label class='gfield_label gform-field-label' for='gform_browse_button_3_42' >Photos<\/label> <div class='ginput_container ginput_container_fileupload'>  <div id='gform_multifile_upload_3_42' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_42&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_42&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_42&quot;,&quot;filelist&quot;:&quot;gform_preview_3_42&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/?gf_page=189c5c62ca1aa45&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;67108864b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:42},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_3_42&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>  <div id='gform_drag_drop_area_3_42' class='gform_drop_area gform-theme-field-control'> <span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_42' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_3_42\"  >Select files<\/button> <\/div>  <\/div> <span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_42'>Max. file size: 64 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_42'><\/ul><!-- Leave <ul> empty to support CSS :empty selector. --><\/div>  <div id='gform_preview_3_42' class='ginput_preview_list'>  <\/div>  <\/div>  <div id=\"field_3_48\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_48\"> <h3 class=\"gsection_title\"><\/h3> <\/div> <fieldset id=\"field_3_45\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_45\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Code of Conduct \/ Policy Violations:<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_3_45'>  <div class='gchoice gchoice_3_45_1'> <input class='gfield-choice-input' name='input_45.1' type='checkbox'  value='Academic Integrity'  id='choice_3_45_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_1' id='label_3_45_1' class='gform-field-label gform-field-label--type-inline'>Academic Integrity<\/label> <\/div>  <div class='gchoice gchoice_3_45_2'> <input class='gfield-choice-input' name='input_45.2' type='checkbox'  value='Alcohol, Drugs, Tobacco'  id='choice_3_45_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_2' id='label_3_45_2' class='gform-field-label gform-field-label--type-inline'>Alcohol, Drugs, Tobacco<\/label> <\/div>  <div class='gchoice gchoice_3_45_3'> <input class='gfield-choice-input' name='input_45.3' type='checkbox'  value='Bullying \/ Hazing'  id='choice_3_45_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_3' id='label_3_45_3' class='gform-field-label gform-field-label--type-inline'>Bullying \/ Hazing<\/label> <\/div>  <div class='gchoice gchoice_3_45_4'> <input class='gfield-choice-input' name='input_45.4' type='checkbox'  value='Disruptive Behavior'  id='choice_3_45_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_4' id='label_3_45_4' class='gform-field-label gform-field-label--type-inline'>Disruptive Behavior<\/label> <\/div>  <div class='gchoice gchoice_3_45_5'> <input class='gfield-choice-input' name='input_45.5' type='checkbox'  value='Harassment'  id='choice_3_45_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_5' id='label_3_45_5' class='gform-field-label gform-field-label--type-inline'>Harassment<\/label> <\/div>  <div class='gchoice gchoice_3_45_6'> <input class='gfield-choice-input' name='input_45.6' type='checkbox'  value='Property Damage'  id='choice_3_45_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_6' id='label_3_45_6' class='gform-field-label gform-field-label--type-inline'>Property Damage<\/label> <\/div>  <div class='gchoice gchoice_3_45_7'> <input class='gfield-choice-input' name='input_45.7' type='checkbox'  value='Technology Misuse'  id='choice_3_45_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_7' id='label_3_45_7' class='gform-field-label gform-field-label--type-inline'>Technology Misuse<\/label> <\/div>  <div class='gchoice gchoice_3_45_8'> <input class='gfield-choice-input' name='input_45.8' type='checkbox'  value='Theft \/ Fraud'  id='choice_3_45_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_8' id='label_3_45_8' class='gform-field-label gform-field-label--type-inline'>Theft \/ Fraud<\/label> <\/div>  <div class='gchoice gchoice_3_45_9'> <input class='gfield-choice-input' name='input_45.9' type='checkbox'  value='Threats \/ Violence'  id='choice_3_45_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_9' id='label_3_45_9' class='gform-field-label gform-field-label--type-inline'>Threats \/ Violence<\/label> <\/div>  <div class='gchoice gchoice_3_45_11'> <input class='gfield-choice-input' name='input_45.11' type='checkbox'  value='Weapons'  id='choice_3_45_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_11' id='label_3_45_11' class='gform-field-label gform-field-label--type-inline'>Weapons<\/label> <\/div>  <div class='gchoice gchoice_3_45_12'> <input class='gfield-choice-input' name='input_45.12' type='checkbox'  value='Other Code of Conduct Concern'  id='choice_3_45_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_45_12' id='label_3_45_12' class='gform-field-label gform-field-label--type-inline'>Other Code of Conduct Concern<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_49\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_49\"> <h3 class=\"gsection_title\"><\/h3> <\/div> <fieldset id=\"field_3_50\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_50\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Choose all that apply:<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_3_50'>  <div class='gchoice gchoice_3_50_1'> <input class='gfield-choice-input' name='input_50.1' type='checkbox'  value='Sex Discrimination'  id='choice_3_50_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_1' id='label_3_50_1' class='gform-field-label gform-field-label--type-inline'>Sex Discrimination<\/label> <\/div>  <div class='gchoice gchoice_3_50_2'> <input class='gfield-choice-input' name='input_50.2' type='checkbox'  value='Sex-Based Harassment'  id='choice_3_50_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_2' id='label_3_50_2' class='gform-field-label gform-field-label--type-inline'>Sex-Based Harassment<\/label> <\/div>  <div class='gchoice gchoice_3_50_3'> <input class='gfield-choice-input' name='input_50.3' type='checkbox'  value='Sexual Harassment'  id='choice_3_50_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_3' id='label_3_50_3' class='gform-field-label gform-field-label--type-inline'>Sexual Harassment<\/label> <\/div>  <div class='gchoice gchoice_3_50_4'> <input class='gfield-choice-input' name='input_50.4' type='checkbox'  value='Sexual Assault'  id='choice_3_50_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_4' id='label_3_50_4' class='gform-field-label gform-field-label--type-inline'>Sexual Assault<\/label> <\/div>  <div class='gchoice gchoice_3_50_5'> <input class='gfield-choice-input' name='input_50.5' type='checkbox'  value='Stalking'  id='choice_3_50_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_5' id='label_3_50_5' class='gform-field-label gform-field-label--type-inline'>Stalking<\/label> <\/div>  <div class='gchoice gchoice_3_50_6'> <input class='gfield-choice-input' name='input_50.6' type='checkbox'  value='Dating Violence'  id='choice_3_50_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_6' id='label_3_50_6' class='gform-field-label gform-field-label--type-inline'>Dating Violence<\/label> <\/div>  <div class='gchoice gchoice_3_50_7'> <input class='gfield-choice-input' name='input_50.7' type='checkbox'  value='Domestic Violence'  id='choice_3_50_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_7' id='label_3_50_7' class='gform-field-label gform-field-label--type-inline'>Domestic Violence<\/label> <\/div>  <div class='gchoice gchoice_3_50_8'> <input class='gfield-choice-input' name='input_50.8' type='checkbox'  value='Retaliation'  id='choice_3_50_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_3_50_8' id='label_3_50_8' class='gform-field-label gform-field-label--type-inline'>Retaliation<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_51\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_51\"> <h3 class=\"gsection_title\">Questions<\/h3> <\/div>  <div id=\"field_3_55\"  class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_55\"> <label class='gfield_label gform-field-label' for='input_3_55' >Please provide a detailed description of the incident\/concern using specific concise, objective language (Who, what, where, when, why, and how).<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label> <div class='ginput_container ginput_container_textarea'> <textarea name='input_55' id='input_3_55' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea> <\/div>  <\/div> <fieldset id=\"field_3_52\"  class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_52\"><legend class='gfield_label gform-field-label'  >Did a Law Enforcement agency respond (i.e., NHC Sheriff Deputy, Wilmington Police Dept., and\/or Campus Security)?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend> <div class='ginput_container ginput_container_radio'>  <div class='gfield_radio' id='input_3_52'>  <div class='gchoice gchoice_3_52_0'> <input class='gfield-choice-input' name='input_52' type='radio' value='Yes'  id='choice_3_52_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_0' id='label_3_52_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label> <\/div>  <div class='gchoice gchoice_3_52_1'> <input class='gfield-choice-input' name='input_52' type='radio' value='No'  id='choice_3_52_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_1' id='label_3_52_1' class='gform-field-label gform-field-label--type-inline'>No<\/label> <\/div>  <div class='gchoice gchoice_3_52_2'> <input class='gfield-choice-input' name='input_52' type='radio' value='I don&#039;t know'  id='choice_3_52_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_3_52_2' id='label_3_52_2' class='gform-field-label gform-field-label--type-inline'>I don't know<\/label> <\/div>  <\/div>  <\/div> <\/fieldset> <div id=\"field_3_53\"  class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_53\"> <label class='gfield_label gform-field-label' for='gform_browse_button_3_53' >Supporting Documentation<\/label> <div class='ginput_container ginput_container_fileupload'>  <div id='gform_multifile_upload_3_53' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_3_53&quot;,&quot;container&quot;:&quot;gform_multifile_upload_3_53&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_3_53&quot;,&quot;filelist&quot;:&quot;gform_preview_3_53&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/?gf_page=189c5c62ca1aa45&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/cfcc.edu\\\/office-of-student-affairs\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;67108864b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:3,&quot;field_id&quot;:53},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_3_53&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>  <div id='gform_drag_drop_area_3_53' class='gform_drop_area gform-theme-field-control'> <span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_3_53' class='button gform_button_select_files' aria-describedby=\"gfield_upload_rules_3_53 gfield_description_3_53\"  >Select files<\/button> <\/div>  <\/div> <span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_3_53'>Max. file size: 64 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_3_53'><\/ul><!-- Leave <ul> empty to support CSS :empty selector. --><\/div>  <div id='gform_preview_3_53' class='ginput_preview_list'>  <\/div>  <div class='gfield_description' id='gfield_description_3_53'> Photos, video, email, and other supporting documents may be attached. <\/div>  <\/div>  <div id=\"field_3_54\"  class=\"gfield gfield--type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_54\"> <strong>Disclaimer: Submission of this report allows Cape Fear Community College to review the information provided and determine appropriate review and follow-up. Submission of a report does not constitute a finding that a violation has occurred or an admission of liability by the College.<\/strong> <\/div>  <div id=\"field_3_65\"  class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_3_65\"> <label class='gfield_label gform-field-label' for='input_3_65' >Comments<\/label> <div class='ginput_container'> <input name='input_65' id='input_3_65' type='text' value='' autocomplete='new-password'\/> <\/div>  <div class='gfield_description' id='gfield_description_3_65'> This field is for validation purposes and should be left unchanged. <\/div>  <\/div>  <\/div>  <\/div>  <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_3' class='gform_button button' value='Submit'  onclick='if(window[\"gf_submitting_3\"]){return false;}  if( !jQuery(\"#gform_3\")[0].checkValidity || 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