CIMS: Reporting A Student Concern
This form is designed to provide Cimarron Middle School's students and community members an opportunity to report serious concerns confidentially to our counseling office. The information provided will be sent to the counselors. If this is an emergency please call 911, call the suicide hotline 1-800-273-8255, or take the person of concern to the Emergency Room.


District reporting resources:   Safe2tell can be reached at 877-542-SAFE and text-a-tip, text 274-637 and start with the message CiMS.  


Reports provided through this form are checked during school hours. During school breaks this will not be checked daily.  Please use the above numbers.
Sign in to Google to save your progress. Learn more
Who are you concerned about? *
If known,  grade of the student you concerned about? *
What is the Concern?  (Please provide as many details as possible) *
*If the student is in immediate danger to self or others, call 911 or the suicide hotline: 1-800-273-8255 prior to filling out this form. Reminder this form may not be checked outside of school hours.
Nature of concern is: *
Check all that apply
Required
Your Name *
(Your name will be kept confidential)
I would appreciate follow up with me, regarding this concern: *
*All party's confidentiality will be protected
If yes, please provide contact information (email/daytime phone number)
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of DCSD. Report Abuse
Google Forms