Campus Concern Reporting

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Name:

Student ID Number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Urgency of Your Concern(Required):

This field is required.

Date of Occurrence(Required):

This field is required.

Location(Required):

This field is required.

Dept. description, if needed:

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If you are not sure which part of FLC you were interacting with, please describe it here.

Involved Parties

Name

Select Role

ID Number

Description of Concern

Give a detailed summary of the concern:(Required) This field is required.

Please identify the person(s) associated with this concern, including any witnesses or FLC employees aware of the issue:(Required) This field is required.

How did you become aware of the issue? (i.e., it happened to me, told to me by others, I observed it, etc.)(Required) This field is required.

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Involved Parties

Description of Concern

Supporting Documentation

Submission