Confirmation of DCS Report
Please complete this form after a report has been made to the Department of Child Protective Services. If you have not made the report and suspect, witness, or have been made aware of possible child abuse and/or neglect, immediately contact DCS at 1-800-800-5556. If your report includes allegations of sexual harassment, sexual assault, gender discrimination, dating/domestic violence, and/or stalking, please also complete the Report to Title IX Coordinator.

This completed form will automatically be sent to IPSPD as well as Employee Relations and/or Title IX as appropriate.
Sign in to Google to save your progress. Learn more
Email *
Your first name *
Your last name *
Your role *
Date of alleged incident. If more than one date, list most recent date and add other details in incident description at the end of form.
Location of Alleged Incident *
If you selected "other" as the location of incident, please state specific school or location here.
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy