Concerning Behavior Form

Online form for reporting concerning behavior.

If this is an emergency contact 911.

If this is not an emergency please complete the form below.

If you prefer, you may download and print the Concerning Behavior Form (Paper Version)

Note: Personally Identifiable Information fields below are optional if you wish to remain anonymous. This form does not capture/record any personal information except what you input in the fields below.

Your Name: (Optional)

First Last

Title/Position: (Optional)

Email: (Optional)

Phone: (Optional)

Address: (Optional)

Street Address Address Line 2 City State ZIP Code

Have you discussed the specific behaviors with the individual(s)?*

Yes
No

Have you attempted to resolve the issue in good faith?*

Yes
No

Campus, Center or Other SCTC Location:*

Urgency of the report:*

High
Low

Date of Incident:*

Time of Incident:*

:

List involved parties including Student ID# if applicable:*

Explanation of Concerning Behavior. Please provide a detailed description of the incident/concerning behavior using specific, concise, and objective language. (Who, What, Where, Why, How and Witnesses if applicable)*

Checking the box "Sign" below constitutes providing an electronic signature for this form:*

Sign

Date*

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A unit of the Technical College System of Georgia

A unit of the
Technical College System of Georgia