Online ACT Report

Please fill out this form completely, with as much detail as indicated. Referrals will be forwarded to a pass-protected email address to ensure privacy. The referrer will receive an automated response confirming that the referral was submitted and received. The referrer will receive feedback within 72 hours of submission, provided the referrer provides his/her contact information.
Online ACT Report
ACT Report
This electronic submission is to be used to report behaviors of concern to the Harcum College environment. If this is an emergency situation on the Bryn Mawr campus please call Campus Safety at 610-526-6099. For all Partnership Sites please call 911.
Would you like to remain anonymous?

Is this ACT Report pertaining to a student?

Is this ACT Report pertaining to an employee of the college?

Time & Location
What was the approximate date and time that the situation occurred?
Bryn Mawr Campus?

Partnership Site?

Choose Partnership Site where this situation occurred:
Where did the situation/incident occur? Please be as specific as possible (for example: in the 3rd floor lobby).
Report Type(s)
Types of Situations to Report:
  • Absenteeism: Frequently absent from class, work, etc.
  • Abuse of Alcohol/Drugs: Shows signs of extreme use of alcohol and/or drug usage.
  • Academic Performance Declining:Grades are declining.
  • Appears to be Depressed: Appears to always be tearful, unhappy and/or has no expression without a known reason.
  • Bullying: Engaged in aggressive behaviors physically, emotionally, and/or verbally.
  • Post Bullying Support for Identified Victim and/or Witness(es)
  • Changes in Demeanor
  • Cutting Behavior: Self injury-cut, carve, burn.
  • Displays Isolation/Alienation: Often alienates themselves and/or fails to interact with others.
  • Suspected Domestic Violence and/or Abuse: Shows signs of being abused emotionally or physically.
  • Post Abuse Support for Identified Victim and/or Witness(es)
  • Extreme Anger/Rage
  • Extreme Anxiety: Shows signs of severe fear and worry.
  • Recurring Lack of Hygiene: Does not seem to care about their hygiene.
  • Extremely Suspicious/Paranoid: Irrational mistrust or suspicion.
  • Fascination with Alleged Injustices: Appears to have obsessive behavior violations/rights of others.
  • Fascination with Offenders of Violence: Appears to be obsesses with people who have committed violent crimes.
  • Makes Others Fearful: Has a threatening demeanor, appearance, and/or expression. Report to Campus Safety immediately.
  • Post Support for Someone Who Has Been Physically Attacked and/or the Witness(es) of the Attack
  • Planning to Commit Violence/Weapon Use: Expressed their intent to commit a violent act and/or use a weapon to harm someone and/or something. Report to Campus Safety immediately.
  • Sexual Assault: Forced or coerced against their will in a sexual act. Report to Campus Safety immediately.
  • Post Sexual Assault Support for Victim(s) and/or Witness(es)
  • Strange Statements: Can be oral and/or written.
  • Suicidal Act or Threat: Can be communicated orally and/or written. Report to Campus Safety immediately.
  • Troublesome Behavior: Behavior displayed causes disturbances or is unusual. Be specific in explanation.
  • Weapon Obsession: Appears to be fixated on weapons.
  • Appearance Causes Distraction in the Academic Setting
  • Resistance & overreaction to changes in policy/procedure
  • Repeated violation of work/classroom policies
  • Empathy with individuals committing violence
  • Noticeably unstable emotional responses
  • Talk of previous incidents of violence
  • Other
Report Type(s):
required Use Ctrl or Shift keys to multi-select.
List other behaviors:
Parties Involved
Please list the names and/or contact information of the individuals in this incident/situation.
Please list names and contact information (if available) for all witnesses to this incident/situation.
Descriptive Information
Please provide as much information as possible about the incident/situation. Indicate what you heard, what was said, observed, and/or if any action was taken.
Result of Report
Thank you for completing this form. Please guide us as to how you would like us to proceed by selecting the options below that apply to this incident/situation.
This Incident/situation is unresolved. Intervention needed.
This incident/situation has been resolved. No further intervention is needed. This report was completed for documentation purposes only.
Incident/situation resolved. Intervention needed.
Incident/situation resolved. Intervention may be needed.
Reporter Contact Info
You can complete this form anonymously and it will be reviewed. If you want someone to provide you with follow-up on this report, contact information needs to be completed.
First Name:
Last Name:
Cell Phone Number: