Musical Empowerment - Suspected Violation of Child Protection Policies Reporting Form
If this is an emergency, please call 911 and ask for the on-call social worker.
If you would like to talk to a Musical Empowerment Staff Member, call 919-891-4383.
This form can be anonymous if you choose and will be reviewed by a member of Musical Empowerment National Staff. Thank you for your dedication to protecting Musical Empowerment students.
Date of incident/observation
Time of incident/observation
Location of incident/observation
Child/Adults involved (full names if possible)
Description of scene/observations made that raised concern (Include: who was involved and what they were doing)
Other previous indicators or observations if known
Your name or other witnesses (not needed if you wish to remain anonymous)
Your contact information - phone/email (not needed if you wish to remain anonymous)
Other actions taken (Were the police, social services, or other groups informed?)
Never submit passwords through Google Forms.
This form was created inside of Musical Empowerment.