SMA Student Reporting Form
This form may be used to report any issues that you are having as a student. You can also report issues that other students are having by using this form. We will use the information that you provide in the most confidential way possible. We may call you in to discuss the incident or issue in more detail if needed. (IF THIS IS AN EMERGENCY OR IF SOMEONE IS IN DANGER, GO DIRECTLY TO AN ADULT AND ASK FOR HELP.)
Today's Date
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Your First Name
Your answer
Your Last Name
Your answer
Your school email address
Your answer
Gender
Your Grade
Date the incident took place
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Where did the incident take place
Required
Please List the names of any students who witnessed the incident
Your answer
Was a teacher present?
Did you report the incident to an adult?
If you reported the incident to an adult, who did you report it to?
Your answer
Describe the incident in as much detail as possible.
Your answer
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