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Student Incident Report
If you have an issue of concern, this form will alert CMS administration. Your answers are confidential. Please be thorough in your answers and descriptions. It is recommended before completing this form that you seek the help of a teacher or parent to help with your concern. If you are not able to solve the issue by yourself, please submit this form and Ms. Wang or Mrs. Woodell will address the concern. Thanks, Go Bears!
Your First and Last Name
Your Grade Level
Date of Incident
Who was involved?
Names (Grade Levels)
Who may be witness(es)?
If known, list first and last name(s) as well as grade level(s).
Location of Incident (check all that apply).
If the incident occurred in the classroom, list classroom in "other."
ELA / Core
Quad (by music rooms)
General Time of Incident (check all that apply):
During instructional time in the classroom
During instructional time outside the classroom
Please describe the incident honestly, completely, and accurately. Start from the beginning and describe the situation.
If you feel you made a mistake, please describe what that might be.
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