2025-2026 VCSC Alleged Child Abuse or Neglect Reporting Form

A report has been made in compliance with I.C. 31-6-11-1 through 31-6-11-21, which provides for the protection of abused or neglected children/youth. By reporting this case, I am acting in good faith on behalf of the protection of the child listed below. Upon completion, this form will be treated as a Confidential Record.
Sign in to Google to save your progress. Learn more
Email *
Check one or more concerns for calling DCS: *
Required
Date: *
MM
/
DD
/
YYYY
School: *
Person Submitting Report *
Relationship to Student *
Student Name *
Birth Date of Child:
MM
/
DD
/
YYYY
Address of Child:
Phone Number of Child:
Time Reported: *
Time
:
Time Called: *
Time
:
DCS Contact:
Report Number: *
Screen In/Out *
Please record the nature of the account in detail. Please include the names of the victim(s) and also the known name of any perpetrator. For reports of educational neglect, please copy and paste the information from the email you sent to DCS. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vigo County School Corporation.

Does this form look suspicious? Report

Google Forms