Campus Crime or Incident Anonymous Report Form - 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

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

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:

Is anyone else aware of the incident?:

Yes
No

I have photo or video evidence of the incident: