This form is for any concerns you may have; things you may have witnessed or heard that make you uncomfortable or make you feel unsafe. Some examples might be: you are worried about somebody harming themselves or others, you are concerned that somebody may be being abused at home, you saw somebody using/selling drugs in the school, etc.
YOUR CONCERNS WILL BE ADDRESSED IN A CONFIDENTIAL MANNER. It is encouraged but not required for you to put your name and contact information on this form. Giving us the opportunity to contact you could help in our ability to intervene. Thank you for helping us to keep our school safe!
Which school is your concern about?
What is your concern?
Abuse at Home
Who is involved?
When did this happen? (Date, class period, etc.)
Where did the concern happen?
Please provide a summary of your concern:
Please leave your name and email address/phone number so that we can follow up with you.
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