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Incident Reporting Form

Incident Reporting (Care Team)

Background Information

If you are an El Centro College student, please include your student ID number in the "Title/Position" field.

Or, you may write Anonymous

Please indicate the relevant category(s) that pertain to this incident report. Indicating values in this box does not mean a student will be found responsible for a violation.


Student Code of Conduct


Involved Parties

Please list up to five (5) individuals involved (excluding yourself) and include any applicable information, such as:

  • Name or Organization
  • Gender
  • Role (Alleged, Victim, Witness, Student of concern)
  • Student ID Number
  • Date of Birth
  • Phone Number
  • Email Address
  • Address

For non-students, please list a SSN or Driver’s License number in the block labeled SID (Student ID #) if available.

Description / Narrative

Please provide a detailed description of the incident/concern using specific concise, objective language (Who, what, where, when, why, and how).

Photos, video, email, and other supporting documents may be attached below.  The maximum size of each file is 15 megabytes (MB). Please click the Upload button after each file is selected.

Supporting Documentation
Files must be less than 15 MB.
Allowed file types: gif jpg png rtf odf pdf doc docx ppt pptx xls xlsx avi mov mp3 ogg wav gz rar tar zip.

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