Safe Sanctuary Initiative Reporting Form

Safe Sanctuary Initiative Reporting Form

This form is for individuals to confidentially report criminal or unethical activity occurring within church organizations, ministries, or leadership. All submissions are reviewed and handled discreetly to protect your privacy.
Section 1: Reporter Information

Optional - You may remain anonymous
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email
example@example.com
YesNo
Section 2: Church/Organization Information
Name Of Church/Organization:
Location (Address, City, State):
Pastor/Leader Name (if known):
Church Website or Social Media (if available):
Section 3: Incident Details
Date Of Incedent

MonthDayYear
Date
Financial MisconductSexual Misconduct Or AbusePhysical AbuseEmotional or Spiritual AbuseCorruption or FraudNegligence or Cover-UpOther
If Other, Please Describe:
Describe in detail what occurred(Include names, actions, dates, and any other relevant information):
Section 4: Evidence or Supporting Information
YesNo
If yes, upload files below!
File Upload

Cancelof
Are there any witnesses or other victims? Please list names or details if known:
Section 5: Desired Outcome
InvestigationLegal Action Or ReferralChurch Accountability Or ClosureSupport/Protection for VictimsOther
If Other, Please Describe:
Section 6: Acknowledgment & Consent
I acknowledge and consent to the terms above.
Signature

Powered by Jotform SignClear
Should be Empty: