Teen Dating Violence Reporting Form

Shrewsbury High School is committed to creating a safe, supportive, and respectful school environment. It is further committed to a climate that is free of violence and harassment among students, staff, and visitors. Shrewsbury High School will not tolerate any displays of teen dating violence in its schools, on school grounds, or at school functions.  Further, retaliation against an individual who has complained about teen dating violence or cooperated in an investigation of teen dating violence will not be tolerated. Shrewsbury High School will respond promptly to complaints and reports of teen dating violence or retaliation and corrective action will be taken where necessary, including disciplinary action where appropriate.

This form is anonymous, therefore, you will need to leave your contact information at the bottom of this form if you would like to be contacted in response to your report.


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Date of the Incident
MM
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Time of the incident/pattern of behavior
Time
:
Where did the incident/pattern of behavior take place?
Who is the victim of the incident/pattern of behavior? Please provide first and last name.
What is the name of the alleged offender?  Please provide first and last name.
What did the alleged offender say or do?
Please indicate how you know about this incident/pattern of behavior
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Please leave your contact information if you want to be contacted about the incident/pattern of behavior. (Name, email, and/or phone number)
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