East Prairie Reporting Form

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This reporting form is checked regularly throughout the school day. If you submit a report after 3:30 PM, the report will be viewed the next work day by an administrator at the building. If your report is an urgent concern for someone’s safety or for your own safety, please contact a trusted adult immediately who can help right away, or call 911.

Not sure if you are contacting the right person? See below for help.

Student name (name of person making the report)

Please understand if you don't share your name, it is very hard for us to investigate. Only administrators see what is reported and your name will be kept confidential. Having your name will help us help you and your friends.

Who is completing this form?
*

Student

Parent/guardian

Homeroom/life skills teacher *

Description of the situation to the best of your ability. Please share as many details as you can.
*

What do you want as a result of sharing this situation?
*

I want help

I want someone else to get help

I want you to know what is going on

Other:

Required

How long has this been going on and/or how many times has this happened?
*

Have you told an adult (teacher, social worker, office staff, principal, etc.) at school about this?
*

Yes

Which adult(s)?

Anything else you would like to share at this time?

Submit

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This form was created inside of East Prairie School District #73. Report Abuse

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