ANONYMOUS REPORTING FORM

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If you or another student are experiencing a problem at Rivercrest ISD, leave your concern below for the administration. You do not need to leave your name.

PLEASE--BE AS SPECIFIC AS POSSIBLE. Leaving times, dates, locations, and other information is crucial to resolving your concern. Again, you do not need to leave your name unless you want an administrator to follow up with you. All messages will be taken seriously and will be worked on promptly. If you are experiencing a serious problem that needs immediate attention, you are urged to tell a teacher, school counselor, principal, school resource officer or other trusted adult as soon as possible.

NAME (NOT REQUIRED)

EMAIL (NOT REQUIRED)

PHONE NUMBER (NOT REQUIRED)

WHAT DO YOU NEED TO REPORT? *

ABUSE (VERBAL, SEXUAL, PHYSICAL, MENTAL)

ANGER ISSUE / LOSS OF SELF-CONTROL

BULLYING / CYBERBULLYING

CUTTING / SELF-HARM

DATING VIOLENCE

DEPRESSION / ANXIETY

DOMESTIC VIOLENCE / CHILD ABUSE

DRUG OR ALCOHOL USE / ABUSE

EATING DISORDER

HATE CRIME / HATE SPEECH / DISCRIMINATION

INAPPROPRIATE BEHAVIOR / LANGUAGE / GESTURE

INAPPROPRIATE PHOTOS / VIDEOS / OTHER GRAPHIC

PLANNED ATTACK / FIGHT / ASSAULT

SUICIDE / SUICIDE IDEATION

VAPING USE / POSSESSION / DISTRIBUTION

WEAPON(S) / EXPLOSIVE DEVICE

Other:

Required

TELL US WHAT IS GOING ON. THE MORE DETAILS YOU PROVIDE, THE BETTER WE CAN HELP. *

WHO IS IN NEED OF HELP? (FIRST & LAST NAME, GRADE LEVEL OR CAMPUS, GENDER, RACE/ETHNICITY) *

WHEN DID OR WILL THE INCIDENT TAKE PLACE? (DATE AND TIME IF POSSIBLE) *

WHERE DID OR WILL THE INCIDENT TAKE PLACE? (LOCATION, SOCIAL MEDIA PLATFORM, SCHOOL EVENT) *

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