Tell Someone
This is an anonymous form designed to empower you to help others. *This is not an emergency or suicide hotline. If someone is making suicidal comments or saying they will hurt themselves, please call their parent/guardians or call 9ll/your local authorities. If you have thoughts of hurting yourself please tell an adult, or call the National Suicide Prevention Hotline at 1-800-273-8255*
Please Categorize your concern: *
If the concern is about harassment/bullying - please complete the following form: goo.gl/tkty3p
Required
I am concerned about (First Name) *
Your answer
Last Name *
Your answer
Information About Your Concern: Please give as much detailed information about your concern as possible. The more information we have about the situation, the better we are able to help. If you witnessed something happening, please give specific locations (ex: Upstairs D hallway by Ms. Durako's room; the boy's bathroom by the cafeteria, etc). *
Your answer
When did this incident occur?
MM
/
DD
/
YYYY
Name of the violator(s) or person(s) causing harm:
Your answer
This form will be submitted anonymously once you hit the "submit" button. However, many times we need additional information in order to help a student. Please know we would not share your name with the person you are concerned about unless you approve it first. We will simply say it was submitted by someone who is concerned about them. If you are willing to provide us with your name, please enter it below. If you would rather remain anonymous, you may skip this question and continue on to submit this form anonymously.
Your answer
Is there anything else we should know?
Your answer
Is there a specific time this is happening?
Your answer
Which school does the student attend? *
Submit
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