Student of Concern/Incident Report Form

In case of an emergency, please dial 911 or reach out to Campus Police at 410-386-8123. For concerns regarding threats to harm oneself or others, please contact 911 or Campus Police at 410-386-8123. If you have any concerns about a Carroll Community College student, kindly complete the Student of Concern & Incident Report Form. When filling out the form, please include your name, title, and contact details, and provide detailed information about the student concern or incident. While anonymous reports are accepted, we encourage you to provide your contact information for potential follow-up. Please note that Carroll Community College student records are safeguarded by the Family Educational Rights and Privacy Act (FERPA). Questions can be directed to studentcare@carrollcc.edu.

Additionally, if you suspect a violation of the Standards of Student Conduct, please submit the Student Conduct Incident Report form. This process is distinct for reporting violations of the Standards of Student Conduct.

Name(Required)

First Last

Your Role / Position / Title:(Required)

Phone(Required)

Email(Required)

Enter Email Confirm Email

Student Concern / Incident Report Details

Please select the type of situation that you are reporting

Type(Required)

Concern (Mental Health, Suicidal, Isolation Grief, etc.)

Human Services Assistance (Food Insecurity, Housing, Transportation, etc.)

Conduct (Disruptive Behavior, Failure to Comply, Facility/Equipment Abuse, etc.)

Academic Integrity (Cheating, Dishonesty, Plagiarism, etc.)

Behavioral Concern (Decline in quality of academic work and performance, frequent absences from classes, withdrawal from school/departmental activities, mood changes, outbursts, changes in appearance, concerning observable behaviors.)

Date(s) & Time(s) of Incident:(Required)

Location of Incident:(Required)

Involved Student(s) Names(Required)

Please provide a detailed description of the student concern/incident using specific concise, objective language.(Required)

Title IX

Any concerns related to Sexual Misconduct should be reported to titleix@carrollcc.edu which will go to the Title IX coordinator, Kiersten Meyers. She will evaluate if the report falls under Title IX, if it does not she will ask the Behavioral Intervention Team to handle the case. For more information on Title IX or to report your concern please visit https://www.carrollcc.edu/Title-IX/Title-IX-/-Sexual-Misconduct/

Campus Alert

Student of Concern/Incident Report Form

Student Concern / Incident Report Details

Title IX