Student Statement Form

Thank you for submitting a student statement regarding your concerns. Please provide as many details as possible, including names, times, and the location of the incident. Administration will thoroughly investigate the matter and follow up with you. Please note, however, that due to privacy regulations, we are unable to disclose any disciplinary actions, if any, taken against the student involved.

We appreciate your courage in bringing this to our attention. If you have any further questions, feel free to contact Mrs. Henry at henryp@sgate.k12.mi.us. YOU MUST CHECK YOUR EMAIL FOR A RESPONSE ON NEXT STEPS.

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First Name *
Last Name *
Email Address
Date of incident *
MM
/
DD
/
YYYY
Location of incident *
What happened? *
Do you feel safe? *
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