Incident Report Form

If there is an incident that school officials should know, please fill out the survey below.  All information provided in the survey is confidential, but it is sometimes helpful to leave your name in case additional clarification or information is needed.
Incident Report Form
Student's name involved
Date of Report:
Date of Alleged Incident:
Location of Alleged Incident (please be as specific as possible):
Description of Incident(s)(Please be as specific as possible):
Name of Witness(es), if any:
Your name (this is optional, but could be helpful in our investigation):

To validate your submission, please answer the following math problem:

4 + 5 =
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