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Anonymous Safety Report
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* Indicates required question
Today's Date
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MM
/
DD
/
YYYY
I am a(n)
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Elementary Student
MYP Scholar
Teacher or Staff Member
Parent
Other
Do YOU feel your safety is at risk right now?
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Yes ----PLEASE GO SEEK OUT a trusted adult ASAP
No
Who are you reporting about? (If multiple students please list all names)
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Your answer
Please describe in as much detail what you are reporting. (Please list dates and times as well as any information we may need to know)
*
Your answer
If you would like to be contacted please leave your name below
Your answer
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