A Better CPTC
Privacy / Release / Acknowledgement
Type of Concern
---- Select Concern ----
Abuse
Academic Dishonesty
Campus Safety/Security Concern
Discrimination
Ethics Violations
Fraud
Harassment
Unsafe Campus/Work Conditions
FERPA Violations
Drug / Alcohol Abuse
Copyright Violations
Other
Describe Concern
Date Occurred
Time Occurred
-Hours-
1
2
3
4
5
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8
9
10
11
12
-Minutes-
00
01
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59
-AM/PM-
AM
PM
Location
Enter the names of any individuals you suspect were involved or witnessed the behavior
Full Name 1
Full Name 3
Full Name 2
Full Name 4
Occurred Before
-- Select Value --
Yes
No
Reported to CPTC
-- Select Value --
Yes
No
Reported off campus
-- Select Value --
Yes
No
Witnesses
-- Select Value --
Yes
No
Anyone Injured
-- Select Value --
Yes
No
You were a target
-- Select Value --
Yes
No
Relationship to CPTC
-- Select Value --
Employee
Student
Faculty
Parent
Business Vendor
Other
Select the best method to contact you and provide contact information
Your Full Name
Please Call
Phone Number
-- When "Please Call" is selected a number is required --
Please Email
Email Address
-- When "Please Email" is selected your email address is required --
Remain Anonymous
Create a password to login and access the current status of this concern
Your Password
Attach File 1
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