LRC incident reporting form

Provide a title for your feedback or report.

Your GVSU email address ending in mail.gvsu.edu. Required for follow-up on you feedback submission.

Community space/culture: feedback or incident reporting about what is happening in the community with specific individuals or groups, or the community climate as a whole.

Campus Climate Concern: report about a specific CCC incident ("any instance where someone feels belittled, disrespected, or isolated based on their identity")

Harassment; discrimination; retaliation; sexual misconduct/assault: report about a specific Title IX-related incident; will likely require follow-up and/or an official report to the Office of Civil Rights and Title IX. See additional Title IX and Mandatory Reporter information below.

Is this a recurring situation, with an individual or group of students?

The specific date of the incident that occurred (to the best of your knowledge), or the date of your feedback. If this is a recurring situation/incident, please provide additional information on past recurrences in the description area at the end of the form.

Who is impacted? Specific individuals or groups that were affected by a particular incident or the feedback you are reporting.

Examples may include individual students/groups, LRC staff, or the LRC community as a whole.

If you don't know the student(s) name(s), please try to describe them as well as you can, e.g. "some members of XYZ club".

Indicate the urgency level of your incident report. Certain types of incidents, such as harassment, discrimination, retaliation or sexual misconduct/assault should be set to "Address immediately", as timely follow-up with appropriate institutional resources such as the Office of Civil Rights and Title IX is likely required.

(Optionally) meet with Chris and/or David in-person to discuss or escalate this feedback or incident report.

Describe your feedback or incident report in as much detail as possible. For incident reports, include names, date/time, and people in the room if you can, and detail what was said, the tone of the conversation, presumed intent of the speaker, and any other detail you feel is relevant to the context of the situation.

If you have a substantial write-up that exceeds 2000 characters, please upload a copy (.docx, .pdf, etc.) separately in the field below.

Any additional documentation, images, etc. that you have to provide additional context to your feedback/incident report.

Accepted filetypes: jpg, jpeg, png, gif, doc, docx, pdf, xls, xlsx.