Anonymous Incident Report
This form is a way to communicate anonymously that inappropriate behaviors have occurred to school and district administrators. If you would like to share your name, you have the option to do that below.
I am a: *
ie: student, parent, community member
Your answer
During this incident I was a(n): *
ie: student, eye witness, victim
Your answer
What is your name?
This is optional. You do not have to type your name, unless you would like administrators to know you are reporting this or you would like to see a counselor.
Your answer
I am in _____ grade. *
If you are not a student, type n/a.
Your answer
What is the name of the student you would like to report? *
If you do not know the name of the student type "unsure" and answer the next question.
Your answer
If you do not know the student's name, please describe the person.
Your answer
Please describe the incident. *
Your answer
Were there witnesses to this incident? *
What are the names of the witnesses?
If there were no witnesses you can leave this blank.
Your answer
How do you feel about this incident or person? *
ie: They are annoying, I hate them, I want to hurt them, they don't make me mad I just want them to stop, etc
Your answer
Did this or other incidents make you feel like harming yourself or others? *
If you would like to speak with a counselor, please provide the best way we can contact you. *
Your answer
What else would you like us to know about this incident?
This is optional.
Your answer
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