{"id":45,"date":"2021-12-13T15:39:00","date_gmt":"2021-12-13T20:39:00","guid":{"rendered":"https:\/\/cfcc.edu\/office-of-student-affairs\/?page_id=45"},"modified":"2024-08-12T15:06:31","modified_gmt":"2024-08-12T19:06:31","slug":"cfcc-student-incident-reporting-form","status":"publish","type":"page","link":"https:\/\/cfcc.edu\/office-of-student-affairs\/cfcc-student-incident-reporting-form\/","title":{"rendered":"CFCC Student Incident Reporting Form"},"content":{"rendered":"<p>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.<\/p>\n<p>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.<\/p>\n<p>Furthermore, the Dean of Student Affairs serves as CFCC\u2019s Title IX Coordinator and has primary responsibility for coordinating the College\u2019s 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.<\/p>\n<p>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&#8217;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 <a href=\"http:\/\/catalog.cfcc.edu\/\"> cfcc.edu\/catalog\/ <\/a> .<\/p>\n<p>* If the person completing this form is a victim\/survivor, you may choose to be anonymous, to ensure confidentiality and safety.<br \/>\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_1' > <form method='post' enctype='multipart\/form-data'  id='gform_1'  action='\/office-of-student-affairs\/wp-json\/wp\/v2\/pages\/45' data-formid='1' novalidate> <div class='gform-body gform_body'>  <div id='gform_fields_1' class='gform_fields top_label form_sublabel_below description_below'>  <div id=\"field_1_7\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_7\"> <h3 class=\"gsection_title\">Background Information<\/h3> <\/div> <fieldset id=\"field_1_1\"  class=\"gfield gfield--type-name field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_1\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Your Full 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_1_1'> <span id='input_1_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_1_1_3' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_1_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_1_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_1_1_6' value=''   aria-required='false'     \/>\n                                                    <label for='input_1_1_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span> <\/div> <\/fieldset> <div id=\"field_1_2\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_2\"> <label class='gfield_label gform-field-label' for='input_1_2' >Your Position\/Title<\/label> <div class='ginput_container ginput_container_text'> <input name='input_2' id='input_1_2' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_3\"  class=\"gfield gfield--type-phone gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_3\"> <label class='gfield_label gform-field-label' for='input_1_3' >Your Phone Number<\/label> <div class='ginput_container ginput_container_phone'> <input name='input_3' id='input_1_3' type='tel' value='' class='large'    aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_4\"  class=\"gfield gfield--type-email gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_4\"> <label class='gfield_label gform-field-label' for='input_1_4' >Your Email Address<\/label> <div class='ginput_container ginput_container_email'> <input name='input_4' id='input_1_4' type='email' value='' class='large'     aria-invalid=\"false\"  \/> <\/div>  <\/div> <fieldset id=\"field_1_23\"  class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_23\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Your Physical Address<\/legend> <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip has_country ginput_container_address gform-grid-row' id='input_1_23' > <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_1_23_1_container' >\n                                        <input type='text' name='input_23.1' id='input_1_23_1' value=''    aria-required='false'    \/>\n                                        <label for='input_1_23_1' id='input_1_23_1_label' class='gform-field-label gform-field-label--type-sub '>Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_1_23_2_container' >\n                                        <input type='text' name='input_23.2' id='input_1_23_2' value=''     aria-required='false'   \/>\n                                        <label for='input_1_23_2' id='input_1_23_2_label' class='gform-field-label gform-field-label--type-sub '>Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_1_23_3_container' >\n                                    <input type='text' name='input_23.3' id='input_1_23_3' value=''    aria-required='false'    \/>\n                                    <label for='input_1_23_3' id='input_1_23_3_label' class='gform-field-label gform-field-label--type-sub '>City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_1_23_4_container' >\n                                        <input type='text' name='input_23.4' id='input_1_23_4' value=''      aria-required='false'    \/>\n                                        <label for='input_1_23_4' id='input_1_23_4_label' class='gform-field-label gform-field-label--type-sub '>State \/ Province \/ Region<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_1_23_5_container' >\n                                    <input type='text' name='input_23.5' id='input_1_23_5' value=''    aria-required='false'    \/>\n                                    <label for='input_1_23_5' id='input_1_23_5_label' class='gform-field-label gform-field-label--type-sub '>ZIP \/ Postal Code<\/label>\n                                <\/span><span class='ginput_right address_country ginput_address_country gform-grid-col' id='input_1_23_6_container' >\n                                        <select name='input_23.6' id='input_1_23_6'   aria-required='false'    ><option value='' selected='selected'><\/option><option value='Afghanistan' >Afghanistan<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo' >Congo<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czechia' >Czechia<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini' >Eswatini<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard Island and McDonald Islands' >Heard Island and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Korea, Democratic People&#039;s Republic of' >Korea, Democratic People&#039;s Republic of<\/option><option value='Korea, Republic of' >Korea, Republic of<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macao' >Macao<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Macedonia' >North Macedonia<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Romania' >Romania<\/option><option value='Russian Federation' >Russian Federation<\/option><option value='Rwanda' >Rwanda<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena, Ascension and Tristan da Cunha' >Saint Helena, Ascension and Tristan da Cunha<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia and the South Sandwich Islands' >South Georgia and the South Sandwich Islands<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen' >Svalbard and Jan Mayen<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria Arab Republic' >Syria Arab Republic<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania, the United Republic of' >Tanzania, the United Republic of<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fcrkiye' >T\u00fcrkiye<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Viet Nam' >Viet Nam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><\/select>\n                                        <label for='input_1_23_6' id='input_1_23_6_label' class='gform-field-label gform-field-label--type-sub '>Country<\/label>\n                                    <\/span> <div class='gf_clear gf_clear_complex'>  <\/div>  <\/div> <\/fieldset><fieldset id=\"field_1_33\"  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_1_33\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nature of this Report (General)<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_1_33'>  <div class='gchoice gchoice_1_33_1'> <input class='gfield-choice-input' name='input_33.1' type='checkbox'  value='Accessibility (ADA)'  id='choice_1_33_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_33_1' id='label_1_33_1' class='gform-field-label gform-field-label--type-inline'>Accessibility (ADA)<\/label> <\/div>  <div class='gchoice gchoice_1_33_2'> <input class='gfield-choice-input' name='input_33.2' type='checkbox'  value='Accident\/Injury'  id='choice_1_33_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_33_2' id='label_1_33_2' class='gform-field-label gform-field-label--type-inline'>Accident\/Injury<\/label> <\/div>  <div class='gchoice gchoice_1_33_3'> <input class='gfield-choice-input' name='input_33.3' type='checkbox'  value='Safety Concern'  id='choice_1_33_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_33_3' id='label_1_33_3' class='gform-field-label gform-field-label--type-inline'>Safety Concern<\/label> <\/div>  <\/div>  <\/div> <\/fieldset><fieldset id=\"field_1_31\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_31\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nature of this Report (Code of Conduct)<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_1_31'>  <div class='gchoice gchoice_1_31_1'> <input class='gfield-choice-input' name='input_31.1' type='checkbox'  value='Academic Integrity (cheating and\/or plagiarism)'  id='choice_1_31_1'   aria-describedby=\"gfield_description_1_31\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_1' id='label_1_31_1' class='gform-field-label gform-field-label--type-inline'>Academic Integrity (cheating and\/or plagiarism)<\/label> <\/div>  <div class='gchoice gchoice_1_31_2'> <input class='gfield-choice-input' name='input_31.2' type='checkbox'  value='Bullying\/Hazing (initiating or participating in verbal, social, or physical bullying; whether in person, through social media, electronic devices, or any other means)'  id='choice_1_31_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_2' id='label_1_31_2' class='gform-field-label gform-field-label--type-inline'>Bullying\/Hazing (initiating or participating in verbal, social, or physical bullying; whether in person, through social media, electronic devices, or any other means)<\/label> <\/div>  <div class='gchoice gchoice_1_31_3'> <input class='gfield-choice-input' name='input_31.3' type='checkbox'  value='Children on Campus'  id='choice_1_31_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_3' id='label_1_31_3' class='gform-field-label gform-field-label--type-inline'>Children on Campus<\/label> <\/div>  <div class='gchoice gchoice_1_31_4'> <input class='gfield-choice-input' name='input_31.4' type='checkbox'  value='Communicating Threats'  id='choice_1_31_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_4' id='label_1_31_4' class='gform-field-label gform-field-label--type-inline'>Communicating Threats<\/label> <\/div>  <div class='gchoice gchoice_1_31_5'> <input class='gfield-choice-input' name='input_31.5' type='checkbox'  value='Computer Acceptable Use'  id='choice_1_31_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_5' id='label_1_31_5' class='gform-field-label gform-field-label--type-inline'>Computer Acceptable Use<\/label> <\/div>  <div class='gchoice gchoice_1_31_6'> <input class='gfield-choice-input' name='input_31.6' type='checkbox'  value='Destruction of College Property'  id='choice_1_31_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_6' id='label_1_31_6' class='gform-field-label gform-field-label--type-inline'>Destruction of College Property<\/label> <\/div>  <div class='gchoice gchoice_1_31_7'> <input class='gfield-choice-input' name='input_31.7' type='checkbox'  value='Discrimination'  id='choice_1_31_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_7' id='label_1_31_7' class='gform-field-label gform-field-label--type-inline'>Discrimination<\/label> <\/div>  <div class='gchoice gchoice_1_31_8'> <input class='gfield-choice-input' name='input_31.8' type='checkbox'  value='Drug, Alcohol and Controlled Substance'  id='choice_1_31_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_8' id='label_1_31_8' class='gform-field-label gform-field-label--type-inline'>Drug, Alcohol and Controlled Substance<\/label> <\/div>  <div class='gchoice gchoice_1_31_9'> <input class='gfield-choice-input' name='input_31.9' type='checkbox'  value='Fighting'  id='choice_1_31_9'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_9' id='label_1_31_9' class='gform-field-label gform-field-label--type-inline'>Fighting<\/label> <\/div>  <div class='gchoice gchoice_1_31_11'> <input class='gfield-choice-input' name='input_31.11' type='checkbox'  value='Forgery'  id='choice_1_31_11'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_11' id='label_1_31_11' class='gform-field-label gform-field-label--type-inline'>Forgery<\/label> <\/div>  <div class='gchoice gchoice_1_31_12'> <input class='gfield-choice-input' name='input_31.12' type='checkbox'  value='Fraud'  id='choice_1_31_12'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_12' id='label_1_31_12' class='gform-field-label gform-field-label--type-inline'>Fraud<\/label> <\/div>  <div class='gchoice gchoice_1_31_13'> <input class='gfield-choice-input' name='input_31.13' type='checkbox'  value='Gambling'  id='choice_1_31_13'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_13' id='label_1_31_13' class='gform-field-label gform-field-label--type-inline'>Gambling<\/label> <\/div>  <div class='gchoice gchoice_1_31_14'> <input class='gfield-choice-input' name='input_31.14' type='checkbox'  value='General Disruptive Behavior'  id='choice_1_31_14'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_14' id='label_1_31_14' class='gform-field-label gform-field-label--type-inline'>General Disruptive Behavior<\/label> <\/div>  <div class='gchoice gchoice_1_31_15'> <input class='gfield-choice-input' name='input_31.15' type='checkbox'  value='Harassment'  id='choice_1_31_15'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_15' id='label_1_31_15' class='gform-field-label gform-field-label--type-inline'>Harassment<\/label> <\/div>  <div class='gchoice gchoice_1_31_16'> <input class='gfield-choice-input' name='input_31.16' type='checkbox'  value='Larceny\/Theft'  id='choice_1_31_16'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_16' id='label_1_31_16' class='gform-field-label gform-field-label--type-inline'>Larceny\/Theft<\/label> <\/div>  <div class='gchoice gchoice_1_31_17'> <input class='gfield-choice-input' name='input_31.17' type='checkbox'  value='Profanity\/Obscene Language'  id='choice_1_31_17'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_17' id='label_1_31_17' class='gform-field-label gform-field-label--type-inline'>Profanity\/Obscene Language<\/label> <\/div>  <div class='gchoice gchoice_1_31_18'> <input class='gfield-choice-input' name='input_31.18' type='checkbox'  value='Sexual Misconduct'  id='choice_1_31_18'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_18' id='label_1_31_18' class='gform-field-label gform-field-label--type-inline'>Sexual Misconduct<\/label> <\/div>  <div class='gchoice gchoice_1_31_19'> <input class='gfield-choice-input' name='input_31.19' type='checkbox'  value='Substance Abuse and\/or Possession (any drug as defined under North Carolina General Statutes)'  id='choice_1_31_19'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_19' id='label_1_31_19' class='gform-field-label gform-field-label--type-inline'>Substance Abuse and\/or Possession (any drug as defined under North Carolina General Statutes)<\/label> <\/div>  <div class='gchoice gchoice_1_31_21'> <input class='gfield-choice-input' name='input_31.21' type='checkbox'  value='Tobacco Free Campus'  id='choice_1_31_21'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_21' id='label_1_31_21' class='gform-field-label gform-field-label--type-inline'>Tobacco Free Campus<\/label> <\/div>  <div class='gchoice gchoice_1_31_22'> <input class='gfield-choice-input' name='input_31.22' type='checkbox'  value='Violation of Federal, State, or Local Law'  id='choice_1_31_22'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_22' id='label_1_31_22' class='gform-field-label gform-field-label--type-inline'>Violation of Federal, State, or Local Law<\/label> <\/div>  <div class='gchoice gchoice_1_31_23'> <input class='gfield-choice-input' name='input_31.23' type='checkbox'  value='Weapons on Campus'  id='choice_1_31_23'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_31_23' id='label_1_31_23' class='gform-field-label gform-field-label--type-inline'>Weapons on Campus<\/label> <\/div>  <\/div>  <\/div>  <div class='gfield_description' id='gfield_description_1_31'> Choose all that apply. <\/div> <\/fieldset><fieldset id=\"field_1_32\"  class=\"gfield gfield--type-checkbox gfield--type-choice gfield--width-full field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_32\"><legend class='gfield_label gform-field-label gfield_label_before_complex'  >Nature of this Report (Title IX)<\/legend> <div class='ginput_container ginput_container_checkbox'>  <div class='gfield_checkbox' id='input_1_32'>  <div class='gchoice gchoice_1_32_1'> <input class='gfield-choice-input' name='input_32.1' type='checkbox'  value='Sex Discrimination'  id='choice_1_32_1'   aria-describedby=\"gfield_description_1_32\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_1' id='label_1_32_1' class='gform-field-label gform-field-label--type-inline'>Sex Discrimination<\/label> <\/div>  <div class='gchoice gchoice_1_32_2'> <input class='gfield-choice-input' name='input_32.2' type='checkbox'  value='Sexual Harassment'  id='choice_1_32_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_2' id='label_1_32_2' class='gform-field-label gform-field-label--type-inline'>Sexual Harassment<\/label> <\/div>  <div class='gchoice gchoice_1_32_3'> <input class='gfield-choice-input' name='input_32.3' type='checkbox'  value='Sex Based Harassment'  id='choice_1_32_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_3' id='label_1_32_3' class='gform-field-label gform-field-label--type-inline'>Sex Based Harassment<\/label> <\/div>  <div class='gchoice gchoice_1_32_4'> <input class='gfield-choice-input' name='input_32.4' type='checkbox'  value='Sexual Assault'  id='choice_1_32_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_4' id='label_1_32_4' class='gform-field-label gform-field-label--type-inline'>Sexual Assault<\/label> <\/div>  <div class='gchoice gchoice_1_32_5'> <input class='gfield-choice-input' name='input_32.5' type='checkbox'  value='Stalking'  id='choice_1_32_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_5' id='label_1_32_5' class='gform-field-label gform-field-label--type-inline'>Stalking<\/label> <\/div>  <div class='gchoice gchoice_1_32_6'> <input class='gfield-choice-input' name='input_32.6' type='checkbox'  value='Dating or Domestic Violence'  id='choice_1_32_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_1_32_6' id='label_1_32_6' class='gform-field-label gform-field-label--type-inline'>Dating or Domestic Violence<\/label> <\/div>  <\/div>  <\/div>  <div class='gfield_description' id='gfield_description_1_32'> Choose all that apply. <\/div> <\/fieldset><fieldset id=\"field_1_9\"  class=\"gfield gfield--type-time gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_9\"><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_1_9'> <input type='number' maxlength='2' name='input_9[]' id='input_1_9_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_1_9_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_9[]' id='input_1_9_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_1_9_2'>Minutes<\/label> <\/div>  <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' > <select name='input_9[]' id='input_1_9_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_1_9_3'>AM\/PM<\/label> <\/div>  <\/div> <\/fieldset> <div id=\"field_1_10\"  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_1_10\"> <label class='gfield_label gform-field-label' for='input_1_10' >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_10' id='input_1_10' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='A Galehouse Building' >A Galehouse Building<\/option><option value='F Workforce Training' >F Workforce Training<\/option><option value='G Economic and Workforce Development' >G Economic and Workforce Development<\/option><option value='HHS Health &amp; Human Services' >HHS Health &amp; Human Services<\/option><option value='K Autobody\/Collision Repair' >K Autobody\/Collision Repair<\/option><option value='L Health Sciences\/LRC' >L Health Sciences\/LRC<\/option><option value='N Natural Sciences' >N Natural Sciences<\/option><option value='P Institutional Services' >P Institutional Services<\/option><option value='R Schwartz Center' >R Schwartz Center<\/option><option value='S McLeod' >S McLeod<\/option><option value='T Information Technology' >T Information Technology<\/option><option value='U Union Station' >U Union Station<\/option><option value='W Emmart\/Burnett' >W Emmart\/Burnett<\/option><option value='WA Wilson Center' >WA Wilson Center<\/option><option value='M Marine Tech\/Dock' >M Marine Tech\/Dock<\/option><option value='Wilma Daniels Gallery' >Wilma Daniels Gallery<\/option><option value='Tabitha&#039;s Courtyard' >Tabitha&#039;s Courtyard<\/option><option value='Sea Devil Bookstore' >Sea Devil Bookstore<\/option><option value='CFCC Campus Safety' >CFCC Campus Safety<\/option><option value='NA McKeithan Center' >NA McKeithan Center<\/option><option value='NB Applied Technologies' >NB Applied Technologies<\/option><option value='NE Building' >NE Building<\/option><\/select> <\/div>  <\/div>  <div id=\"field_1_11\"  class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_11\"> <label class='gfield_label gform-field-label' for='input_1_11' >Specific Location<\/label> <div class='ginput_container ginput_container_text'> <input name='input_11' id='input_1_11' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_12\"  class=\"gfield gfield--type-section gsection field_sublabel_below gfield--has-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_12\"> <h3 class=\"gsection_title\">Involved Parties<\/h3> <div class='gsection_description' id='gfield_description_1_12'> 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. <\/div>  <\/div>  <div id=\"field_1_14\"  class=\"gfield gfield--type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_14\"> <label class='gfield_label gform-field-label' for='input_1_14' >Name or Organization<\/label> <div class='ginput_container ginput_container_text'> <input name='input_14' id='input_1_14' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_15\"  class=\"gfield gfield--type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_15\"> <label class='gfield_label gform-field-label' for='input_1_15' >Select Gender<\/label> <div class='ginput_container ginput_container_select'> <select name='input_15' id='input_1_15' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><option value='Other' >Other<\/option><\/select> <\/div>  <\/div>  <div id=\"field_1_16\"  class=\"gfield gfield--type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_16\"> <label class='gfield_label gform-field-label' for='input_1_16' >Select Role<\/label> <div class='ginput_container ginput_container_select'> <select name='input_16' id='input_1_16' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please Select<\/option><option value='Reporting Party' >Reporting Party<\/option><option value='Responding Party' >Responding Party<\/option><option value='Victim' >Victim<\/option><option value='Witness' >Witness<\/option><option value='Student of Concern' >Student of Concern<\/option><\/select> <\/div>  <\/div>  <div id=\"field_1_17\"  class=\"gfield gfield--type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_17\"> <label class='gfield_label gform-field-label' for='input_1_17' >ID Number<\/label> <div class='ginput_container ginput_container_text'> <input name='input_17' id='input_1_17' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_18\"  class=\"gfield gfield--type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_18\"> <label class='gfield_label gform-field-label' for='input_1_18' >Date<\/label> <div class='ginput_container ginput_container_date'> <input name='input_18' id='input_1_18' type='text' value='' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_1_18_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_1_18_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span> <\/div> <input type='hidden' id='gforms_calendar_icon_input_1_18' class='gform_hidden' value='https:\/\/cfcc.edu\/office-of-student-affairs\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/> <\/div>  <div id=\"field_1_19\"  class=\"gfield gfield--type-phone gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_19\"> <label class='gfield_label gform-field-label' for='input_1_19' >Phone Number<\/label> <div class='ginput_container ginput_container_phone'> <input name='input_19' id='input_1_19' type='tel' value='' class='large'    aria-invalid=\"false\"   \/> <\/div>  <\/div>  <div id=\"field_1_20\"  class=\"gfield gfield--type-email gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_20\"> <label class='gfield_label gform-field-label' for='input_1_20' >Email<\/label> <div class='ginput_container ginput_container_email'> <input name='input_20' id='input_1_20' type='email' value='' class='large'     aria-invalid=\"false\"  \/> <\/div>  <\/div>  <div id=\"field_1_24\"  class=\"gfield gfield--type-text gfield--width-quarter field_sublabel_below gfield--no-description field_description_below gfield_visibility_visible\"  data-js-reload=\"field_1_24\"> <label class='gfield_label gform-field-label' for='input_1_24' >Address<\/label> <div class='ginput_container ginput_container_text'> <input name='input_24' id='input_1_24' type='text' value='' class='large'      aria-invalid=\"false\"   \/> 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