BTAT Report Form

Report General Information

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Your full name:

Title:

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Please state if student, faculty, staff, or other identifying information

Your phone number:

Your email address:

Email address must be of a valid format.

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UIC email address preferred

Nature of this report(Required):

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Incident Description

Urgency of this report(Required):

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Date of incident(Required):

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Time of incident:

Location of incident(Required):

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Specific location:

Involved Parties

Name or Organization

Select Gender

Select Role

ID Number

Phone number

Email address

Hall/Address

Questions

Please describe in as much detail as possible.

What occurred, who was involved, and when did it take place?(Required) This field is required.

Are you a student, faculty, staff, or other?(Required)

Student Faculty Staff Other

You must make at least one selection.

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. 5GB maximum total size.
Attachments require time to upload, so please be patient after submitting this form.

Email me a copy of this report

Report General Information

Involved Parties

Questions

Supporting Documentation

Submission