Anonymous Reporting

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Anonymous Reporting

Name: This is not a required, but would be appreciated. This report will be kept confidential and your identity will remain anonymous.

In order to address this incident quickly, please choose the school that this incident impacts. If this incident impacts more than one school, please choose only one and then write additional names in the comments section:

Fieler

Iddings

Miller

Salk

Wood

MIS

CPMS

MHS

Other:

Clear selection

When did this incident occur? (if this incident has not yet occurred, but there have been threats made, please indicate when the threats were made):

YYYY

Where did this incident happen? If there was more than one incident, please select the location of the most recent incident. If there are multiple locations or you would like to elaborate on the location, please write in the box below.

In the Classroom

In the Hallway

On the Bus

In the Cafeteria

Outside of School

On the Internet

Other:

Clear selection

Name of the target of this incident (if there is more than 1 target, please write one name in this box and then write the other names in the comments section):

Comments

Grade (if there is more than one grade, pick the grade for the target named above):

Name of the perpetrator(s) of this incident (if you do not know the name of the perpetrator, please write unknown.):

Were there any witnesses? (if yes, please list names or a description of who they are, ex. young boy with a blue hoodie, adult that looked like a security guard):

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Merrillville Community School Corporation.

Does this form look suspicious? Report

Forms