CARE Team Reporting Form

Please use this form to submit concerns and/or report an incident that affects a member of the TUC community. This is an anonymous reporting form. All information is voluntary and you are not required to complete any particular fields. You may leave blank any field on this form that you wish. However, the more information you give to the C.A.R.E. Team the more likely it will be that the Team will be able to provide an effective response to your concerns. All information the Team will have will be the data you provide on the form below.

Thank you for reaching out to the TUC C.A.R.E. to help create a more supportive and safe campus environment.

Your Name

Your Position/Title

Student
Faculty
Administrator

Your Phone Number

Your Email Address

Nature of Report

Concerning Behaviors
Concerning Life Events/Stressors
Illness/Wellness Related Concerns
Threatening Behavior
Conduct Violation
Safety and or Security Report
Other (Place Clarify Briefly)

Urgency of your Report

Informational Only
Not Urgent
Urgent

Location of Incident

Involved Parties
Please list the person (s) of concern or otherwise involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, if available, please list and Employee ID# or Driver's License number in the block labeled Student ID#. The most important fields are the name, ID number and contact information

Name of Individual

Role in Incident

Student ID# if known

Date of Birth

Phone Number

Email address

Address if known

Incident Description