Restraint/Seclusion Incident Report
* Required
Student's Full Name
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Other:
Required
Ethnicity
*
Asian
Black or African American
American Indian or Alaska Native
Hispanic
Multiracial
Native Hawaiian or Pacific Islander
White
Other:
Location of Incident
*
Your answer
Date of Incident
*
MM
/
DD
/
YYYY
Time of Incident
*
Time
:
AM
PM
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