Sport Protection Reporting Form
Offender Information
This section is about the individual you are reporting. Please provide as much information as possible.
Name of the Individual you are reporting:
First Name
Last Name
Gender
Male
Female
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Position(s) this individual holds or held:
Head Coach / Instructor
Assistant Coach
Employee
Other / Not Sure
Organization where individual works and/or volunteers or worked/volunteered previously:
Incident Information
This section asks questions about the incident or incidents you are reporting Please provide as much specific information as you are able.
Type of Offense (i.e. what happened?):
Where did the incident take place? (City, State and any other available location information)
Please describe what happened: (Including... Who, What, When, Where)
Victim Information
This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please only enter your age, state, and chapter affiliation.
Name:
First Name
Last Name
Chapter/Organizational Affiliation (if any):
Contact phone number (Note, if this person is under 18, please provide contact information for his/her parent or guardian):
Please enter a valid phone number.
Contact Email Address (Note, if this person is under 18, please provide contact information for his/her parent or guardian):
example@example.com
Age:
Gender
Male
Female
Reporter's Information
You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she believes to be true.
Name
First Name
Last Name
Phone Number
Please enter a valid phone number.
Email
example@example.com
Chapter/Organizational Affiliation (if any):
Relation to victim (if any):
Self
Parent/Guardian
Other Family Member
Friend or Acquaintance
Chapter Member, Coach or Volunteer
Other or Prefer not to day
Other Information
If you have other information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here:
Submit
Should be Empty: