Submit a Report. Make a Difference.
Required fields are asterisk (*) in red, others are optional
State
*
-- Select State --
Abia
Adamawa
Akwa Ibom
Anambra
Bauchi
Benue
Borno
Bayelsa
Cross River
Delta
Ebonyi
Edo
Ekiti
Enugu
Federal Capital Territory
Gombe
Imo
Jigawa
Kebbi
Kaduna
Kano
Kogi
Katsina
Kwara
Lagos
Nasarawa
Niger
Ogun
Ondo
Osun
Oyo
Plateau
Rivers
Sokoto
Taraba
Yobe
Zamfara
Local Government
*
-- Select Local Government --
School Name
*
-- Select School --
Event Description: (Including... Who, What, When, Where and How Do You Know)
*
Concern/Event Types
*
-- Select Event Type --
Anger Issues
Assaults
Blackmail
Bullying
Child Abuse
Cyber-Bullying
Depression
Discrimination
Domestic Violence
Drugs
Explosives
Fighting
Fire Outbreak
Gangs
Harassment
Planned School Attack
Requesting Information
Runaway
School Safety Concern: Facility
School Safety Concern: Policy
School Safety Concern: Staff
Self-Harm
Sexting
Sexual Misconduct
Suicide
Theft
Threats
Transportation Complaints
Vandalism
What time and date did the event occur to the best of your recollection?
Was Social Media (Facebook, Twitter, Texting, etc.) used to express the problem? If so, select from one of the following:
-- Select Platform --
Facebook
Twitter
Instagram
Snapchat
Texting
Email
Other
Associated Social Media Username or URL
How did you hear about our program?
Persons Involved Details.
Persons Involved:
1
Add +
Remove -
Person Involved #1
First Name
Last Name
Nickname
Grade
-- Select Grade --
Kindergarten
Nursery
Basic 1
Basic 2
Basic 3
Basic 4
Basic 5
Basic 6
Basic 7
Basic 8
Basic 9
SSS 1
SSS 2
SSS 3
Gender
-- Select Gender --
Male
Female
Role
-- Select Role --
Victim
Aggressor
Witness
Age or DOB
Eyes/Glasses
Hair Color/Style
Facial Hair
Body Type/Build
Scars, Marks, Tattoos, Piercings
DL# or ID#
Clothing
Address
Description of Residence
Prior Criminal History
Weapons
Dogs/Animals
Gang Activity
Employer / Work Schedule
Any Other Comments
Vehicle Details.
Vehicle:
1
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Remove -
Vehicle #1
Make
Model
Year
Colour
License Plate
State
Description (any identifying marks, bumper stickers, company logos, etc.)
File Upload
File Upload
File Description
Upload Limit: 100MB (File Types: Images, Videos, Audio, Documents)
Submit Anonymously
