INCIDENT REPORTING FORM

Please use this form to file a concern with the Office of Student Affairs at Andrew College. Submission of this form initiates further inquiry of the issue and may lead to formal charges under the Student Code of Conduct. (If you have questions about this process prior to filing a concern, please contact the Office of Student Affairs at 229-732-5950.)

Examples of behaviors appropriate for this form include, but are not limited to:

*Violation of college policy
 or specific college directive

*Disruption of classroom or college activities
*Violation of an applicable law
*Physical assault

*Sexual misconduct, sexual assault, sexual harassment, stalking 

*Relationship abuse (verbal, physical, sexual, mental, etc.)
*Theft of property or services
*Threats

*Hazing

*Hate crimes
*Alcohol- and drug-related violations
*Intentional or reckless property damage 

*Falsifying a document

*Impersonating another
 person
*Computer violations






If you are considering filing a student concern related to sexual assault, sexual harassment, relationship violence, or stalking, we encourage you to contact Whitney Mosley, Deputy Title IX Coordinator and Compliance Officer, at 229-732-5950 or whitneymosley@andrewcollege.edu.

In the narrative, please outline as much information about the concern as possible, including what happened, when and where the incident occurred, who was involved/has direct knowledge of the incident, the student(s) involved, how it came to your attention, and what steps have been taken thus far. (If you would like to submit an anonymous report, you may do so, but the college may be limited in the scope of the follow-up we can provide.)

Relevant materials may include written statements, photographs, police reports, and other records.

All information provided becomes an educational record and may be shared with the responding student if formal charges are filed, and may be used as documentation if the concern proceeds to a hearing. Confidentiality of educational records is outlined by the Federal Education Rights and Privacy Act (FERPA).

    BACKGROUND INFORMATION

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    INVOLVED PARTIES

    Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. Please enter the student(s) Andrew College ID numbers, if available.
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    DESCRIPTION / NARRATIVE

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    ADDITIONAL QUESTIONS

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    SUPPORTING DOCUMENTS

    Please e-mail any photos, video, email, and/ or other supporting documents to whitneymosley@andrewcollege.edu