C.A.R.E. Incident Report

C.A.R.E. Incident Report

This Incident Report Form can be used by faculty, staff, and students. The purpose is to inform the MC CARE Team, co-chaired by the Title IX Coordinator and MCPD (this is in place of the SOBI form), of concerning behavior. This behavior can include behavior targeting others, disorderly conduct/disruptive behavior, drugs and alcohol, student(s) in need (Support Our Students - SOS), MC property damage, misuse of MC Technology, sexual harassment, suicidal comments, or any other concerning behavior.

This form can also be used for students in need of community resources (i.e. Support Our Students - SOS).

This form is NOT for academic reporting (i.e. stopped coming to class, not turning in work, etc.).

Once the form is submitted it will be emailed to the co-chairs of the CARE Team and you will be contacted regarding the incident.


* Indicates a required field

Contact Information

(###) ###-####

Incident Information

Please be specific. Location, building, room, etc.

Involved Parties

Please list the individuals involved (excluding yourself), including as many of the listed fields as you can provide. If a non-student is involved, list as much information as you can under NAME or ORGANIZATION.


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

Supporting Documentation

If you have photos, video, email, or other supporting documents, please send as an email attachment to: care@midland.edu.



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