Help keep our university community safe. This form is for reporting emerging situations involving behavior that may impact the safety of the university community but has not escalated into an emergency. Such situations involve disturbing or distressing behavior exhibited by faculty, staff, students or guests. If this is an emergency, contact NEIU Police at x5511. If your concern is strictly a student conduct issue with no safety concern, contact the Student Rights & Responsibilities Office at SRR@neiu.edu or x4610. Person of Concern (POC) Information "Person of Concern" is the individual who has exhibited the disturbing or distressing behavior. POC Alias (if any exists) POC Description (gender, height, weight, age, ethnicity, hair color, eye color, distinguishing marks or clothing) POC Status Student Faculty Administrator University guest Unknown Other… Please specify POC Phone Number Reporter Information? Reporter Status Student Faculty Staff Administrator University Guest Other… Please specify Your Phone Number Your Email Address Can we contact you? Yes No Best way to reach you Phone Email Please do not contact me Incident Date Incident Date: Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Incident Date: Day Day12345678910111213141516171819202122232425262728293031 Incident Date: Year Year1900190119021903190419051906190719081909191019111912191319141915191619171918191919201921192219231924192519261927192819291930193119321933193419351936193719381939194019411942194319441945194619471948194919501951195219531954195519561957195819591960196119621963196419651966196719681969197019711972197319741975197619771978197919801981198219831984198519861987198819891990199119921993199419951996199719981999200020012002200320042005200620072008200920102011201220132014201520162017201820192020202120222023202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050 Incident Time Incident Location Police Report None Filed with university police Filed with other police entity Others involved and witnesses to the concerning behavior Description of incident and concerning behavior Type of Supporting Documents Emails or Text Messages Photos Recordings (audio or visual) Computer Screen Shots Documents (hard copy and electronic) Police Report Emails or Text Messages Other… Please Specify Other Please send all supporting documents to BCT@neiu.edu or deliver to the Chair of the BCT in B-119. Submit
