Request edit access
Student Concern Report
Your information will be kept private between you and school guidance/administration. Depending on what is shared, we may need more information and need to speak with you for more details.
* Required
Email address
*
Your email
Name
*
Your answer
Name of student(s) you are concerned about
*
Your answer
Type of concern
*
Abuse
Alcohol/Drugs
Bullying
Depression
Fight
Suicide
Weapon
Other:
Required
Provide important details (State what YOU heard or witnessed)
*
Examples include date, time, location, and any other relevant information
Your answer
Are there any other students who could confirm what you shared or add valuable information? (Include first and last names)
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of York Suburban School District.
Report Abuse
Forms
