Title IX Grievance/Anonymous Incident Reporting Form

Objectives of Incident Report

The main objective of the the incident report is to allow FSCC and its community members to ensure, through open communication, that FSCC’s codes of conduct are protecting members of the campus community from harm due to the indiscretion of those on campus who are unable or unwilling to respect the rights of others and/or have violated college rules and regulations as listed in the Student Handbook. Misconduct is considered a matter of concern to administrators, faculty, staff and students alike. Reports of misconduct are usually made to the Vice President of Student Affairs for investigation and determination of appropriate action.

Process of Reporting

If a person is an immediate threat to themselves or someone else or is incapable of caring for themselves, CALL 911.

Any individual may make an anonymous report concerning an act of sexual misconduct and/or individuals who have violated college rules and regulations as listed in the Student Handbook. An individual may report the incident without disclosing his or her name, identifying the respondent or requesting any action. Depending on the level of information available about the incident or the individuals involved, the college’s ability to respond to an anonymous report may be limited, however, this is a form that allows anyone to report suspected misconduct or other issues with complete confidentiality. This service allows the person making the report and college administrators to confer about additional details, while the reporting party’s identity remains confidential. All reports will go to the Vice President of Student Affairs.

Background Information

Nature of this report(Required)

Untitled

Urgency of this report

Date of incident(Required)

Time of incident

Specific location

Reasons for Report

Aberrant Behavior

College

Community

Community Disturbance

Off-Campus Housing Concern

Housing

Residence Hall Violation

For more information on Residence Hall Violations, see the Dorm Handbook.

Please list the individuals involved (excluding yourself). If there are more than 3 people you’d like to provide information about, please also use the Additional People box. For non-students, please list a SSN or Drivers License number in the block labeled SID (Student ID #) if available.

Person 1

Name or organization

Gender

Role

ID number

Date of birth

Phone

Hall / Address

Person 2

Name or organization

Role

Gender

ID number

Date of birth

Phone

Hall / Address

Person3

Name or organization

Gender

Role

ID number

Date of birth

Phone

Hall / Address

Description / Narrative

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).

Additional Questions

Did police respond?

Yes

Did fire respond?

Yes

Did EMS respond?

Yes

How would you prefer to receive follow-up

Phone

Do not contact

Optional Information

An individual may report the incident without disclosing his or her name, identifying the respondent or requesting any action. Depending on the level of information available about the incident or the individuals involved, the college’s ability to respond to an anonymous report may be limited, however, this is a form that allows anyone to report suspected misconduct or other issues with complete confidentiality. This service allows the person making the report and college administrators to confer about additional details, while the reporting party’s identity remains confidential. All reports will go to the Vice President of Student Affairs.

Name

First Last

Your position/title

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. Maximum 8 megabytes per file Attachments require time to upload, so please be patient after you click to submit this report. If your document is larger than 8 megabytes, please send it to the Office of the Vice President of Student Affairs.

File

Max. file size: 50 MB.

In addition to utilizing the statutorily created political subdivisions of the state complaint process:

Consumer protection and/or fraud complaints may be filed with the Kansas Attorney General’s office.
Discrimination complaints may be filed with the Kansas Human Rights Commission.
Complaints regarding State Authorization Reciprocity Agreement (SARA) courses delivered by SARA member community colleges may be filed by students enrolled in those courses with the Kansas Board of Regents office.
Kansas Community Colleges are regionally accredited by the North Central Association of the Higher Learning Commission on Colleges and Universities (NCAHLC). Complaints regarding an institution’s ongoing ability to meet the Criteria of Accreditation may be filed by following the guidelines at https://www.hlcommission.org/HLC-Institutions/complaints.html.

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