Incident Report Form

Contact Information

Name:*

First NameLast Name

Email:*

example@example.com

Phone Number:*

Area CodePhone Number

Demographic:*

Incident Details:

I would like to report the following incident of abuse, harassment or assault.

I would like this incident to be reported to the Board of Directors.

Submit Incident Report

By submitting this report I verify it to be true. I understand that this report will be sent to a local pastor for accountability. It will also be sent to my Director of Student Development (for students), the Academic Dean and the President of Prairie. It will also be automatically sent to a member of the Board of Directors if I have checked that box. In the event of criminal activity, it is your right to contact the RCMP directly and Prairie encourages you to do so. For current abuse, harassment and assault policies, please click here.