Colorado Division of Youth Services
Third Party Reporting for Alleged Sexual Abuse, Sexual Assault, and Sexual Harassment
Please provide the youth's information
First Name
Last Name
Please list the youth's facility/location
Youth Center Name
Please provide details of the alleged incident
Date and time of alleged incident
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Please provide information on who was involved
Describe what happened:
Location of alleged incident:
How did it occur?
Please provide any other important information that you would like to share:
Please provide your information (you may also remain anonymous):
Your name (optional)
First Name
Last Name
Phone number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Email (optional)
example@example.com
Submit
Should be Empty: