Incident Reporting Form

Liberty University cares about members of our community and thus strives to create a safe environment. This form is designed to permit faculty, staff, or students to report concerning behavior that was witnessed regarding another member of the University community. While you may request confidentiality with regards to your report, a request of confidentiality cannot be guaranteed, especially when the safety of the community is of concern.

Thank you for caring enough to alert Liberty University of a community member who may need assistance. Your report will normally be reviewed within 24 hours. If additional information is required you may be contacted. If you believe that immediate attention is required please contact LUPD (434-592-3911), local law enforcement (911), or the Dean of Students Office (434-582-2320).

Background Information


Reason(s) for Report*

Please enter a reason for this report

Please select any of the concerning behaviors that apply to this report.
**If this is an emergency please contact LUPD 434-592-3911

Acts motivated by hatred or discrimination Anxiety Classroom disruption
Depression Disoriented Thinking/Expression Disruption (other than classroom)
Alcohol consumption / Drunkenness Excessive class absenteeism Financial Problems
Flat effect or extreme lack of responsiveness Grief from loss Harassment
Hazing or bullying Homeless Hospitalization
Hygine concerns Medical concerns Observed self-injurous behavior (cutting, burning, exc.)
Relationship violence Risky behavior Social isolation
Stalking Suicidal attempts Suicidal gestures (erasing hard drive, giving away belongings)
Suicidal ideation (Ive always thought about it) Suicidal threats Threatening online postings on social media
Threatening words or actions Writings that convey clear intentions to harm self or others Violation of code of honor

Description / Narrative

Additional Questions

Supporting Documentation

Photos, video, email, and other supporting documents may be attached by email at Please ensure that your email includes your name, LibertyID, date, and approximate time that this form was sent.