Anonymous Report of Campus Crime or Incident - Florida Southern College in Lakeland, FL

Nature of incident (check all that apply)

Vandalism/Building Damage Harassment Bias/Incivility Violence Weapons Theft Drugs/Drug Paraphernalia Mental Illness Other

Other

Location incident occurred

Residence Hall On-campus Apartment Community On-campus Non-Residential Off-Campus Don't Know

Please provide details of the incident

Date/Time of Incident

Status of the person targeted by the incident

Student Staff/Administrator Faculty Non-Student Unknown

Gender of survivor/complainant

Female Male Trans Identifying Gender Queer - Gender Non-Conforming Different Identity Prefer Not to Answer

Accused/Respondent status

Student Staff/Administrator Faculty Non-Student Unknown

Gender of accused/respondent

Female Male Trans Identifying Gender Queer - Gender Non-conforming Different Identity Prefer Not to Answer

Respondent First Name

Respondent Last Name

If you are not the complainant, how did you learn of this incident?

Complainant Told by the survivor/complainant Told by the accused/respondent Told by another party Other

Date incident reported to you

I would like to identify myself or receive help from the Office of Accountability, Education and Compliance

Last Name

Would you like someone from any of these offices to follow up with you?

Student Counseling Center Campus Ministries Campus Safety and Security Student Health Center Academic Center for Excellence

Is anyone else aware of the incident?

I have photo or video evidence of the incident

Please select a file