Code of Conduct Reporting Form

Your Information

While anonymous reports are accepted, you are strongly encouraged to provide your name and contact information in order to allow the College to effectively address the concern you are reporting.

Your full name:

Your Role at WITCC:

Learn more

employee, faculty, learner, guest

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Learn more

Type of concern

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Learn more

Campus Location

Involved Parties

Please be sure to add your own information and then add a new entry for each additional person involved.

Person Name or Organization

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Questions

Describe the Code of Conduct Incident:(Required) This field is required.

What is your relationship to the student(s) involved?(Required) This field is required.

Briefly describe any discussions you have had with the student regarding this concern?(Required) This field is required.

Would you be comfortable visiting with a member of the WITCC Code of Conduct office in follow up to this reported concern?(Required) This field is required.

I understand that this request form is NOT to be used for emergencies requiring an immediate response, and this report will not be viewed outside of normal business hours, holidays, campus closure, etc. Code of Conduct reports will be followed up on within 3 WITCC business days. For emergencies contact WITCC Campus Safety Office at (712) 274-6414(Required)

Yes No

You must make at least one selection.

Supporting Documentation

Supporting Documentation such as Emails, Texts, Photos, Video, or other attachments may be uploaded below. 5G Total capacity for the entire report. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Select copy recipients

DeanofStudents@witcc.edu

Email me a copy of this report

Your Information

Involved Parties

Questions

Supporting Documentation

Select copy recipients

Submission