IF YOU NEED TO REPORT AN EMERGENCY. DO NOT USE THIS FORM. INSTEAD, CALL PARKLAND PUBLIC SAFETY AT 217-351-2369 OR DIAL 911.

By filing out this form you do not wish Parkland College to be officially informed of this incident. This means you only want to talk with a confidential advisor about the information submitted.

If you wish for Parkland College to be officially informed of this incident and would like to authorize a report to be sent to the Title IX Coordinator which alerts Parkland College to officially respond to the incident. Please click here to report the incident.

If you do not wish to file an online form you may contact the confidential advisors at the Parkland College Counseling Services at 217-351-2219 or come to room U267 during business hours. Please ask to speak to one of the confidential advisors or mental health counselors upon your arrival.

You may choose to report anonymously but please note that anonymous reporting will significantly limit the college’s ability to respond.




Person Submitting Form


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Incident Information


For the next three questions, please include as much information and detail as you can. Please provide real names and contact information when possible.

Law Enforcement Reporting

Has this incident been reported to law enforcement?


College Knowledge
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