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Report a Concern

If the Person You Are Reporting Poses a Threat of Harm to Self or Other Call Campus Safety at (304) 367-4357 (HELP) or 911 Immediately

This form is for use by Pierpont C&TC students, faculty, staff, parents and community partners.  Please provide detailed information regarding the concern you are reporting. Once the form is received, the Pierpont Campus Assessment, Response, Evaluation (CARE) Team will review the information and take appropriate action, which may or may not include contacting the person of concern, you, and any witnesses you have identified.  Our goal is to intervene before the situation reaches crisis level.

Confidentiality - The CARE team will take reasonable steps to maintain the privacy of those who complete this report if so requested. It may not always be possible due to the nature of the concern (your identity may be evident), but the CARE team will contact you to address any concerns you may have regarding your identity. 
 
While you have the option to report anonymously, it may not be possible for the team to act upon information without being able to contact someone who may be aware of the situation.
 

Background Information

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Date of Incident
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Involved Parties

Please list the person(s) of concern or otherwise involved (excluding yourself), including as many of the listed fields as you can provide. For non-students, please list an Employee ID#, SSN or Drivers License number in the block labeled Student ID# if available. The most important fields are the name, ID number and contact information. If multiple parties were involved in the incident, you may add or remove them below.

First Person

Date of Birth
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Second Person

Date of Birth
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Third Person

Date of Birth
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Fourth Person

Date of Birth
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Fith Person

Date of Birth
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Sixth Person

Date of Birth
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Seventh Person

Date of Birth
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Eighth Person

Date of Birth
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Ninth Person

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Tenth Person

Date of Birth

Information Regarding Concern

Description / Narrative

Supporting Documentation

Files must be less than 8 MB. Allowed file types: gif jpg jpeg png txt rtf html pdf doc docx avi mov mp3 ogg wav zip.
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