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Person of Concern Reporting Form

If you need to report an emergency, do not use this form. Instead, call the HSC Police Department at (817) 735-2600, or dial 911 if you are off campus.

You can also make an anonymous report via the Trust Line at (844) 692-6025 or www.unthsc.ethicspoint.com. Reports can also be submitted directly to the Compliance Office at 817-735-5131.

Please provide detailed information regarding the incident you are reporting.

Reporting Options:

General Incident report for concerns or actions that are experienced or observed and present a danger to an individual or the Health Science Center community.
Care Team Referral report for concerns or actions that are experienced or observed and are worrisome but do not present an immediate danger to self or others.
Academic Integrity report for incidents involving academic dishonesty violations of the Health Science Center Student Code of Conduct & Civility. If you have access, please upload a copy of the syllabus.
Student Conduct Concern report for incidents involving behavioral violations of the Health Science Center Student Code of Conduct & Civility.
Public Safety report for reports being submitted by or for the HSC Police Department.
Incidents of sexual misconduct (sexual harassment, sexual assault, sexual coercion, and sexual exploitation), domestic violence, dating violence and stalking should use this form to report to the Title IX Coordinator.

Once a report has been received, the Division of Student Affairs or Human Resources (if an employee) will with the person(s) to address the reported concern or alleged misconduct. Please know that you and any witnesses you identify in the report may be contacted by Division of Student Affairs staff for further information. Actions taken as a result of this report and with regard to reports of alleged Student Code of Conduct & Civility violations may be protected by the federal privacy law FERPA (Family Education Rights and Privacy Act), and therefore, become confidential information and may not be shared with you without the direct written consent of the student(s) involved.

If you have any questions regarding filing a Person of Concern Report, please contact the Division of Student Affairs at (817) 735-2505.

Background Information

If you wish to make an anonymous report of concerning or worrisome behavior, the report will be evaluated to determine what follow-up (if any) is necessary to address the concerns. Please consider providing your name and contact information to allow us to call or email if we have additional questions regarding your report.

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Your full name:

Your title/role:

Your phone number:

Your email address:

Email address must be of a valid format.

Nature of this report(Required):

This field is required.

Urgency of this report(Required):

This field is required.

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Parties

Please list the individuals involved (excluding yourself) beginning with the person you are concerned about, followed by others who may have more information or who may have been involved, including as many of the listed fields as you can provide.

Name of Student (or student organization if applicable)

ID Number (e.g. 108123456)

Phone number

Email address

Tell Us About Your Concerns

Supporting Documentation

For cases of suspected academic dishonesty, please include a copy of the original assignment and a copy of the course syllabus. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report