Ignite Mentoring Disclosure Form

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Please enter details concerning any incident that involves student welfare.

With Ignite Mentoring's disclosure policy, you must report any comments the students have made relating to their welfare directly to their teacher after class. We require you to fill out this form so we know that the disclosure has been reported to the teacher.

Once you have verbally reported details to the teacher, they then have full responsibility for discerning what action needs to be taken and whether to report to the Department of Child Protection.

If you would like some assistance after receiving the disclosure, then Ignite Mentoring can arrange support services through the Guild.

Please enter the date the disclosure occurred:

YYYY

Please enter your name: *

Please enter your mobile number:

Please list all other mentors involved: *

Please enter the school at which the incident occurred: *

Has the student's teacher been notified: *

Yes

Would you like a member of the executive to contact you regarding this incident? *

Yes

Would you like Ignite to arrange supports services through the Guild?

Yes

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Optional Ignite Mentoring Detailed Disclosure Form

If the classroom teacher has requested a written copy of the disclosure, or you don’t manage to speak to the teacher after class, then download the following document and record the exact information the student disclosed to you. Ask your coordinators for the teacher's email and send the document directly to the teacher.

https://docs.google.com/document/d/1Pv5MCEeG0IE0XgQWsFzeop1ObhxkA-xntE_cWVOvnRk/edit?usp=sharing

Thank you for taking the time to fill out this form. Remember, please don't discuss the details of what the student said to you with your coordinators or any other mentors. This is because it is sensitive information and we should respect that. We also don’t want other mentors or coordinators behaving differently around the child. If they do this, then the child may realise their information was passed around and may be less likely to disclose in the future.

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