Grand Island Public Schools
123 South Webb Road
Grand Island, NE 68802
Your Legacy.
Their Opportunity.

Enhancing opportunities by seeking and securing resources for projects, scholarships and programs.

Access digital copies of our district flyers.

Improving school-to-home communication by distribute school flyers directly to families digitally.

Incident Report Suspected Abuse


Incident Report

Suspected Abuse

 

Name of Student Involved:                                                                                                                                                            

       
       

 

 

Birthdate:                                                  Male                          Female                                                                         

 

Parent or Guardian:                                                                                                     Phone:                                    

 

Address:                                                                                                         

 

                                                                                                                             

 

Name of Alleged Abuser:                                                                                                                                                               

 

Date and Place of Incident or Incidents:                                                                                                               

 

                                                                                                                                                                                                                       

 

Description of Misconduct (Attach report if necessary):                                                                             

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

 

 

Name of Witnesses (Complete witness report):                                                                                                                

1)                                                                                                                                                                                                                   

 

2)                                                                                                                                                                                                                   

 

Other Information (Inc. evidence of abuse, i.e. letters, photos, etc.):            

 

 

 

 

 

 

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

                                                                                                                                                                                                                       

Signature of Investigator                                                                                          Date

 

Witness Disclosure Form

 

Name of Witness:                                                                                                                                                                                

 

Position of Witness:                                                                                                                                                         

 

Date of Testimony, Interview:                                                                                                                                     

 

Description of Instance Witnessed (Attach report if necessary):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Information:

 

 

 

 

 

 

 

 

 

 

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

                                                                                                                                                                                                                       

Signature of Witness                                                                                                  Date

 

Media Inquiries
Jack Sheard, Marketing & Communications
308-385-5900 Ext. 1127
Grand Island Public Schools
123 South Webb Road
Grand Island, NE 68802
Your Legacy.
Their Opportunity.

Enhancing opportunities by seeking and securing resources for projects, scholarships and programs.

Access digital copies of our district flyers.

Improving school-to-home communication by distribute school flyers directly to families digitally.

Incident Report Suspected Abuse


Incident Report

Suspected Abuse

 

Name of Student Involved:                                                                                                                                                            

       
       

 

 

Birthdate:                                                  Male                          Female                                                                         

 

Parent or Guardian:                                                                                                     Phone:                                    

 

Address:                                                                                                         

 

                                                                                                                             

 

Name of Alleged Abuser:                                                                                                                                                               

 

Date and Place of Incident or Incidents:                                                                                                               

 

                                                                                                                                                                                                                       

 

Description of Misconduct (Attach report if necessary):                                                                             

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

                                                                                                                                                                                                                       

 

 

 

Name of Witnesses (Complete witness report):                                                                                                                

1)                                                                                                                                                                                                                   

 

2)                                                                                                                                                                                                                   

 

Other Information (Inc. evidence of abuse, i.e. letters, photos, etc.):            

 

 

 

 

 

 

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

                                                                                                                                                                                                                       

Signature of Investigator                                                                                          Date

 

Witness Disclosure Form

 

Name of Witness:                                                                                                                                                                                

 

Position of Witness:                                                                                                                                                         

 

Date of Testimony, Interview:                                                                                                                                     

 

Description of Instance Witnessed (Attach report if necessary):

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Other Information:

 

 

 

 

 

 

 

 

 

 

 

I agree that all of the information on this form is accurate and true to the best of my knowledge.

 

                                                                                                                                                                                                                       

Signature of Witness                                                                                                  Date

 

Media Inquiries
Jack Sheard, Marketing & Communications
308-385-5900 Ext. 1127
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