Please complete this form if you have credible information of inappropriate behavior that you feel warrants investigating. In order for this report to be investigated you must provide your name and the names of any others involved. Be as descriptive as possible. Any formal disciplinary action will not be based solely on the submission or evidence contained in this report.
Teacher Referring (first and last name)
(This is a required question and will be kept confidential)
Student(s) Involved in incident?
When did the incident occur?
Please include date and approximate time
Where did the incident happen?
Give a description of the incident.
Please be as specific as possible.
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