MAKE AN ANONYMOUS REPORT
Please use this form to report bullying, harassment, abuse, drug issues or concerns about the safety of your own life or the life of another person (e.g., suicide, self-injury, potential acts of viloence, etc.)

The information you provide will be emailed to a school staff member who will check his or her email DURING REGULAR SCHOOL HOURS.

If you or someone you know is in IMMEDIATE DANGER, please
- CALL 911

NOTE:
This system is completely CONFIDENTIAL and ANONYMOUS. However, providing your name and contact information is very helpful.

Name (Optional but recommended)
Your answer
Email (Optional but recommended)
Your answer
Phone (Optional but recommended)
Your answer
Issue or Incident being reported *
Date of Incident *
MM
/
DD
/
YYYY
Location where Incident took Place *
Your answer
Your connection to the Incident *
Please describe the Incident (Include information on the suspect, victims, or bystanders. The more detail you provide the better.) *
Your answer
What sort of help would you like to see as a result of our investigation of this issue? *
Your answer
Have you notified anyone else of this issue? Yes or No. If yes, who? *
Your answer
Additional Information
Your answer
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