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Prior Lake High School Confidential Reporting System
Note: Your information will be kept confidential with office staff.
506.1 Bullying Prohibition
Click on this link for full PLSAS policy:
https://www.priorlake-savage.k12.mn.us/uploaded/School_Board/Policies/500/506.1-_Bullying_Prohibition.pdf
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* Indicates required question
I agree this is NOT a false report
*
Yes
I am a
*
Student
Parent/Guardian
Employee
Concerned Community Member
Other:
First Name
Your answer
Last name
Your answer
Phone Number
Your answer
Email Address
Your answer
Best time to contact you
Your answer
Approximate Date of Incident
MM
/
DD
/
YYYY
Approximate Time of Incident
Time
:
AM
PM
I am reporting an incident as a
Witness
Victim
Other:
Clear selection
Nature of incident
Acts of Violence/Threats
Bullying/Harrassment
Sexual Assault
Substance Abuse
Suicide/Mental Health Concerns
Vandalism
Weapons/Safety Issues
Other:
Clear selection
Where did it happen?
Your answer
Description of your concern
Your answer
Who does it involve?
Your answer
What did you see or hear?
Your answer
Do you know the people involved?
Your answer
Do you think it will happen again?
Your answer
Additional comments
Your answer
If this concerns someone other than yourself, what is their name?
Your answer
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