Please state the name, address, position and telephone number (if known) of the person suspected or accused ofsexual misconduct with a minor.
Please state the name, sex, age, address and telephone number of the child who has been or is suspected to be the victim of sexual misconduct or abuse.
Please provide a description of the incident of sexual abuse, including the date, time and location of each act of sexual abuse.
Please provide the names, positions, addresses and telephone numbers of all eyewitnesses or others having relevant information.
Please provide any additional information bearing on the incident that may be helpful to an investigation.
You always have the right to directly contact the Department of Children and Families. Their hotline number is 1-800-922-5330.
This form once submitted will be handled by Mr. Charles Befort of the Diocesan Review Board