Handle With Care
This form is for reporting officials ONLY.

Please fill out this form to help Dillon Elementary School District #10 better serve our students by letting us know when a student has been involved in a traumatic event or accident. We will use this information to support this student and ensure his or her needs are met at school.

Fill out one per student. This information will be sent to the the superintendent, building principals, and school counselors.
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Students Name: (First, Last) *
Age: *
Incident Date: *
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Reporting Agency *
Contact Information of Person Making Report: *
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