Person making report: (This is optional, however by giving us your name it will make a thorough investigation easier.)
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I am a: *
Day Time Phone Number (optional)
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Address (optional)
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Email Address (optional)
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Person or Persons That Are The Target of Inappropriate Behavior (Please provide first and last names.) *
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Person or Persons That Are Behaving Inappropriately (Please provide first and last names.)
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Date of Incident *
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Time of Incident *
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Location Where Incident Occurred (Be as specific as possible.) *
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Type of Harassment *
Witnesses (List people who saw or heard the incident or that have relevant information about the incident. Please tell us if the witness is a parent, staff member, student or community member.) *
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Description of Incident *
Describe the incident in detail, including the name of the person or persons involved, what was said and done, and specific words used. *
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