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Galveston College Campus Security and Safety

Incident Report

This Incident Report is for incidents of Sexual Assault, Sexual Misconduct, Sexual Harassment, Dating or Domestic Violence, and Stalking ONLY.    Filing this incident report constitutes official notice to Galveston College and authorizes the institution to investigate the information and allegations contained within the report and seek resolution.  Please be advised, if the report is submitted anonymously the College will be unable to inform you of the outcome.

Submitting this report notifies the following College entities of the incident:

  • Acting Vice President of Student Services, Mr. Ron Crumedy
    • Title IX Coordinator, Dr. Mary Jan Lantz
    • Director of Facilities and Security, Mr. Tim Setzer

Filing this incident report is only for resolution and DOES NOT constitute filing an official police report with either the Galveston College Security Department or the City of Galveston Police Department. To file an official police report, please contact the Galveston College Security Department at 409-996-7663 (or dial “0” from a campus phone) or in person at the Mary Moody Northen Building, Room 105 (for incidents occurring on Galveston College Campus Property) or the City of Galveston Police Department at 409-797-3702 or in person at 601 54th Street, Galveston (for incidents occurring off campus).

Please complete this form as thoroughly as possible, providing as much information as you have access to or knowledge of.

Date Submitted (required)

Your Information

Your First Name (optional)

Your Last Name (optional)

Email (optional)

Your Role in the Incident (required)

What is your role at the college? (required)

What is your gender? (optional)

Address (optional)

City (optional)

State (optional)

Zip Code (optional)

Phone Number (optional)

Incident Details

Alleged Violator's Name (required)

What is the alleged violator's gender? (required)

What is the alleged violator's role at the college? (required)

Alleged Violation(s) (required)

Other Violation(s)

Date of Incident (required)

Time of Incident (required)

Description of the Incident (required)

Location of the Incident (required)

Witness Information

Witness Name

What is the witness' role at the college? (required)

Witness Address

Witness Phone Number

Second Witness Name

What is the second witness' role at the college? (required)

Second Witness Address

Second Witness Phone Number

Third Witness Name

What is the third witness' role at the college? (required)

Third Witness Address

Third Witness Phone Number

Attach supporting documentation.