LaGuardia ACTs Information Form

Contact Us

LAGCCACTS@lagcc.cuny.edu

This field is for validation purposes and should be left unchanged.

I am submitting a concern about(Required)

Full Name of Reporter(Required)

First Last

Are you filling out this form as a:(Required)

Phone Number(Required)

Email Address

Incident Information

Student Full Name(s) (if known)

First Last

EMPLID

Date of incident(Required)

Location(Required)

Time of incident(Required)

Incident Details(Required)

Please share details about the observed incident; this includes what happened, who was involved, any witnesses, location details, behaviors, language, and any other noteworthy information.

Do you have any supporting documents, such as, photos, texts, videos? If so, upload here:

For files larger than 4 MB, email LAGCCACTS@lagcc.cuny.edu

Drop files here or

Accepted file types: pdf, jpg, png, docx, Max. file size: 4 MB, Max. files: 4.

Do you believe this student is at risk for harming him/herself?(Required)

Do you believe this student is at risk for harming others?(Required)

Have you reported these concerns to anyone on campus?(Required)

Name of person who you reported these concerns to(Required)

First Last

Have you spoken to the student about these concerns?(Required)

Student of Concern Information

Student Full Name(s) (if known)

First Last

EMPLID

Pattern of concerning behaviors and/or expressions(Required)

Please share details about the pattern of concerning behaviors and/or concerns; what’s happening, who is involved, any witnesses, location details, relevant dates & duration, behaviors, language, and any other noteworthy information.

Do you have any supporting documents, such as, photos, texts, videos? If so, upload here:

For files larger than 4 MB, email LAGCCACTS@lagcc.cuny.edu

Drop files here or

Accepted file types: pdf, jpg, png, docx, Max. file size: 4 MB, Max. files: 4.

Do you believe this student is at risk for harming him/herself?(Required)

Do you believe this student is at risk for harming others?(Required)

Have you reported these concerns to anyone on campus?(Required)

Name of person who you reported these concerns to(Required)

First Last

Have you spoken to the student about these concerns?(Required)