MPCC Sexual Misconduct Reporting Form

If this is an emergency, call 911 or contact Safety and Security at 308-344-8036 immediately.

This form is intended to provide Mid-Plains Community College (MPCC) community members (students, employees, vendors, and campus visitors) an online means to report incidents of sexual harassment, misconduct, discrimination or retaliation for making such reports.

For more detailed information on MPCC's policies regarding Sexual Misconduct and Title IX, visit the MPCC Title IX webpage.

Who is submitting the report?

Anonymous Reporting

Submitting this form anonymously is your decision to make.  However, please understand that if you choose to submit this report anonymously, the MPCC inquiry into your report will be limited.

Reporter Name

Reporter Connection to MPCC

Reporter Cell Phone Number

Reporter E-mail Address

Tell us about the date, time, and location of the incident.

Date and time of incident/first concern.

Location of incident/concern

Who is involved in the incident?

Please list the individuals involved (excluding yourself) and complete as many of the listed fields as you are able. Once you have added the information, click "Add Involved Individual".

NOTE: You can add multiple individuals into this field by repeating this process as many times as needed.

Name

ID Number

Phone Number

Email Address

Involved Individual(s)

Tell us about the details of the incident?

Please complete the following information. Be professional, accurate and factual. If you did not witness the incident, what is the name of the individual who told you about it and what is their relationship with the person of concern?  Note: Information shared here may be disclosed to the person who is the subject of this report.

Briefly describe the incident/concern using specific, concise, objective language.

Briefly describe the desired solution using specific, concise, objective language.

If you have taken steps to resolve the issue, please share them here using specific, concise, objective language.

Are you aware of any additional developments since the incident?

If yes, please describe the additional information here.

What remedy (outcome) are you seeking? If you are unsure, please write "Unsure".

Supporting Documentation

Please attach or describe any documentation you have to support your report of this incident. Social media posts, text message exchanges, audio or video recordings, photos, or any other item you believe will help us better understand your report.

You can only attach one supporting document to this form. If you have more than one document to share please indicate that below and you will have the opportunity to share the documentation at a later time.

Photos, video, email, and other supporting documents may be attached below. 5GB maximum total size.