Community Reporting Form

This form must be completed if you wish to report concerns about an individual who you recognize as acting contrary to guidance issued by the Centers for Disease Control and Prevention (“CDC”), the Louisiana Department of Health (“LDH”), or the University of Louisiana at Lafayette’s (“University”) COVID-19 and Public Health-Informed Policies found in the Code of Student Conduct. To view guidance and policies referenced above, please see: CDC guidelines, LDH guidance, and University COVID-19 and Public Health-Informed Policies.

Please note that the University will review and analyze all reports for the appropriate response by the University; however the University will not be acknowledging receipt of your complaint and, due to privacy concerns, is unable to provide information to you about any action taken related to the information you have provided.

All personal information requested in this Community Reporting Form is being collected under the Family Educational Rights and Privacy Act (FERPA) and Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule. Please be advised that your personal information is being collected and protected under FERPA and HIPAA for confirmation purposes only and will not be disclosed to the individual(s) whom you are reporting.