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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.

CARE Report Form

Background Information

Name(Required)
Address(Required)
Urgency of this Report(Required)
Nature of this Report(Required)
Date of Incident(Required)

Involved Parties

Please list the person(s) of concern or otherwise involved (excluding yourself), including as much information that you can provide. List an Employee ID# or Student ID# if available. The most important information to include is the name, ID number and contact information. If multiple parties were involved in the incident please list them as well.
I am concerned about the following(Required)
Please provide a detailed description of the incident/concern using specific, concise, objective language.
Have you addressed the concern directly with the individual?(Required)
Has any police agency been notified?(Required)
Was the individual transported to the hospital, jail, or back home with family?(Required)
Is the individual aware that the care team is being notified on their behalf?(Required)
If necessary, may we share your name with the individual?(Required)
Drop files here or
Max. file size: 99 MB, Max. files: 5.