Churchill Institute of Higher Education

How do you identify yourself to Churchill Institute Institute of Higher Education? *

First Name *

Last Name *

Email *

Verify Email Address *

Are any of the following impacted? (Select if applicable)

Information Technology Systems Operational Technology Systems Customer or Staff/Student Data

Date the incident was identified *

Time the incident was identified *

Is the incident ongoing? *

Yes No

Severity of the incident *

Provide a brief description of the incident *

Attach Files (Screenshots, Documents)

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OS Used

Browser Used

Device Used

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