RFHS Anonymous Reporting Form
NOTE: Information included in this form goes privately to the Campus Critical Incidence Response Coordinator. All submissions are reviewed and investigated.

The following form collects information on incidences of bullying, threats to the campus, sexual assault, sexual harassment, dating/domestic violence, or stalking. If you wish to report something not covered by these topics you may do so in the narrative section

If you would like to speak privately to someone, please call (361) 790-2220 x2046. You can also e-mail tgraham@acisd.org.

If this is an emergency situation, please ensure the safety of affected individuals before completing this form.
Your Name or Anonymous
Your answer
Email Address
Your answer
Phone Number
Your answer
Today's Date *
MM
/
DD
/
YYYY
Affiliation with the Incident *
Type of Incident(s) *
Required
Have you reported this incident to anyone else at Rockport-Fulton High School before today? *
The following questions ask about the incident(s) that you are reporting. If any of the information is unknown, please leave the question blank.
Be as detailed as possible.
Victim's Name
Your answer
Victim's Gender
Victim's Age
Your answer
Date of Incident
Your answer
Approximate Time of Incident
Your answer
Victim's Affiliation with RFHS
Include any additional relevant information you feel is important.
Your answer
Alleged Perpetrator's Name
Your answer
Alleged Perpetrator's Gender
Alleged Perpetrator's Age
Your answer
Alleged Perpetrator's affiliation with RFHS
Location of the Incident
How do the victim and alleged perpetrator know each other?
Your answer
Provide a description of the incident (Who, What, When, How, & Why) *
Your answer
Do you wish for a RFHS counselor or administrator to contact you?
Thank for your time and willingness to make RFHS a safe environment for education.
Submit
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