Wildcats Aware: Concerning Behavior Reporting Form

General Information

For assistance with the "Clery Act Reporting" item below, this document contains definitions of all crimes for which the Clery Act requires reporting: https://www.northwestern.edu/up/docs/CleryActReportableCrimes-Locations.pdf.

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Your full name:

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*While it is not required that you submit your name, the BCT's ability to follow up may be limited.

Your position/title:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Clery Act Reporting(Required):

This field is required.

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Are you reporting a crime under the Clery Act?

Date of incident(Required):

This field is required.

Time of incident:

Location of incident(Required):

This field is required.

Specific location:

Involved Individuals or Parties

Please list all the individuals or parties involved, including as many of the listed fields as you can provide. For individuals not affiliated with Northwestern, please provide as much information as possible about the individual in the "Tell Us About Your Concern" section below.

When selecting the “Role” for each individual you include below, please refer to the following definitions:

Subject of Concern: a person or organization who is the subject of the report, whether for a wellness concern, or because they are alleged to have violated University policy.
Complainant/Impacted Party: an individual impacted by the actions of another person or organization, particularly if those actions are alleged to have violated University policy.
Person with Information: an individual who has information about the reported situation, or the persons involved in it, whether or not they directly observed the situation.
Other: other

Name or Organization

Select Gender

Select Role

ID Number

DOB (YYYY-MM-DD)

Phone number

Email address

Hall/Address

Tell Us About Your Concerns

Supporting Documentation

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

General Information

Involved Individuals or Parties

Tell Us About Your Concerns

Supporting Documentation

Submission