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Professionalism Concerns and Mistreatment Report (PCMR) - Incident Report
This report will be read by the Student Resolution Advocate Only
Would you like to be anonymous in reporting this incident? Unless you give permission otherwise, your communications -including that you made a contact- are confidential. (Exceptions to absolute privacy may be notification to authorities when there is a reasonable expectation of imminent harm to you or by you.)
Would you like this incident to remain confidential to the CHM Student Resolution Advocate?
Exceptions to absolute confidentiality include notification to authorities when there is a reasonable expectation of imminent harm, mandated reporting consistent with expectations of the Clery Act (crime on or near campus), and compliance with the Title IX and MSU Sexual Harassment reporting mandates. Please ask the Student Resolution Advocate if you are uncertain about any limits of confidentiality.
In confidential settings, the Student Resolution Advocate may reveal enough information to investigate, if indicated and requested below.
Please discuss confidentiality with me, my contact information is below.
Please describe what happened.
Where / Setting?
Please describe any steps you have you already taken to resolve the issue and/or notify someone about the incident or enter "none."
Please describe the reaction, feelings, or concerns about this incident.
Do you want this incident investigated or do you just want us to be aware of the incident?
Yes, investigate now.
No, don't investigate, just be aware.
Please discuss possible responses with me.
Do you hope for a particular outcome given this report and/or interaction with the Student Resolution Advocate?
Yes, please describe desired outcome.
No, but keep this report in mind as the learning environment is assessed.
Which campus or community are you in?
East Lansing / Lansing
Upper Peninsula Regional
Other, please specify.
What academic year, level or program are you in?
MD Year 3 or LCE
MD Year 4
Extended Legacy Preclinical
Extended Legacy Clinical
Epidemiology and Biostatics
Other, please specify.
May the Student Resolution Advocate contact you?
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