Please fill out as much of this form as possible.

Remember, all information given to us is confidential.

Name  

Email  

Age 

Level in School (Grade or year in college) 

School Name  

What religion is your school part of?  

Is this something that happened to you or another student?  

Please describe in detail (the more info the better) what exactly happened at your school.

Please tell us if this is the first time you/they have experienced this at your school and if the incident/discipline happened with teachers or administration knowing about it.

Please tell us any additional information you would like us to know about this situation.

Does your school have an "honor code" in the student handbook?  

Are their/your parents aware of what happened? 

If so, are your/their parents supporting them/you or the school? 

Can we email you at your email address to talk more about this? 

Thank you so much for completing this incident report.  It takes a lot of courage to stand up for yourself or someone you know.  Remember, you are not alone.

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