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Lance Middle School Anonymous Safety Alert
Please Note:
This form is for Lance Middle School ONLY. The Anonymous Safety Alert is a tool for reporting sensitive information to school officials. This may include violence towards a student or staff member, drug use/ possession, sexual harassment, bullying, threats, weapons, emergency assistance, gang activity, or any inappropriate behavior. School officials and local enforcement agencies will be forwarded this information.

The Safety Alert is anonymous, however, it sometimes help to know who reported the incident to contact for further details.

Time: *
Date: *
Please describe your location when this event occurred. *
Grade level of student(s) involved:
Please let us know if you are one of the following: *
Name of person(s) endangering student safety/ exhibiting misconduct or inappropriate behavior: *
Your answer
Description of problem/ event: *
Your answer
OPTIONAL: Please provide your name:
This is only used if further details are needed in the investigation for appropriate follow up.
Your answer
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