Self-Initiated Incident Report
Share the incident details and any involved parties, and indicate whether you reported it to law enforcement.
Incident Information
Incident Type
*
Please Select
Title IX
Theft
Vandalism
Public Property
Other
Date of Incident
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Clery Geography Classification (select one)
*
On-Campus Non-Residential
On-Campus Housing
Public Property Adjacent
Other
Involved Parties
Person(s) Involved
External Agency Involvement
Did you report to local law enforcement?
*
Yes
No
External Law Enforcement Case #
Person Reporting
REPORT ANONYMOUSLY
*
Yes
No
If No
Please fill out the following:
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
@rockford.edu
Incident Details
*
Note: Confidentiality limits are anonymous when reporting anonymously.
Submit Report
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