Please complete this form for any safety issue or concern. Please indicate which school you attend and the administrators at that site will be emailed when your form is submitted.

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First Name: *

Last Name: *

What school do you attend? *

What grade are you in? *

* Required

Are you a student or a parent?

What happened? *

Incident type: *

Who else saw this happen?

When did this happen? *

Where did this happen? *

Upload any screenshots here.

Are you afraid for your safety? *