Off-Campus Concern Report

Please provide a narrative below of the incident you are reporting. Include names if known.

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Your full name:

Your phone number:

Your email address:

Email address must be of a valid format.

Your physical address:

Date of incident(Required):

This field is required.

Time of incident:

Specific location:

Please include the names of the involved parties if this information is available.

Name or Organization

Select Gender

Phone number

Email address

Address of incident

Have you reported this concern to the Fairfield Police Department?

Please provide a narrative below of the incident you are reporting.(Required) This field is required.

Have you reported this concern to the Fairfield Police Department?(Required)

yes no

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.

Email me a copy of this report

Please provide a narrative below of the incident you are reporting. Include names if known.

Please include the names of the involved parties if this information is available.

Have you reported this concern to the Fairfield Police Department?

Supporting Documentation

Submission