Adaptive Sports New England Sport Protection Reporting
Offender Information
This section is about the individual you are reporting. Please provide as much information as possible.
Name of individual you are reporting:
*
First Name
Last Name
Gender:
*
Male
Female
Other
If you selected other, please specify:
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
Volunteer
Other
Not Sure
If you selected other, please specify:
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 a you are able.
Please describe what happened: (including... who, what, where, when)
*
Where did the incident or incidents take place? (city, state, and any other available information)
*
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 age and gender.
Name:
First Name
Last Name
Age (or approximate age):
*
Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Contact phone number (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 (if this person is under 18, please provide contact information for parent or guardian):
example@example.com
Gender:
*
Male
Female
Other
If you selected other, please specify:
Reporter's Information:
You may remain anonymous. However, providing information is vastly helpful and often necessary to ensure a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequences 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 Address:
example@example.com
Relationship to victim (if any):
*
Self
Parent/Guardian
Other Family Member
Friend or Acquaintance
Organization Member, Coach, or Volunteer
Other
Prefer not to Say
If you selected other, please specify:
Other Information:
If you have any 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: