Aerial view of campus with Williamsport, the Susquehanna River and Bald Eagle Mountain as a backdrop

Incident Report

Once the report is received, appropriate Lycoming staff will address your concerns and may contact you. Please note that anonymously submitted reports may limit our effectiveness in dealing with concerning behavior.

This report form should not be used in an emergency. For emergencies, call 911 or campus security at (570) 321-4911.

Background Information

If you wish to remain anonymous you do not need to include your name. Please note that reporting concerns anonymously may impede our ability to appropriately handle some issues.

Your Full Name

Your Phone #: (555) 555-5555

Your Email

Date of Incident (if unknown, use today)

Time of Incident

AM/PM

Location of incident

Involved Parties

Please list the individuals involved (excluding yourself) if any. Please be sure to include as many of the listed fields as you can provide.

Name

Gender

Role

ID Number

Phone

Address

Add Another Involved Party

Details

Please provide a description of the incident, behavior, or concern in as much detail as possible

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