Sport Protection Report

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 NameLast Name
Gender of the individual you are reporting:

MaleFemaleNon-binaryTransgenderCisgenderPrefer not to answerOther
Address: (City/State required)

Street Address

Street Address Line 2

CityState

Zip Code
Position(s) this individual holds or held: (Select all that apply)

Head Coach/InstructorAssistant CoachEmployeeVolunteerOther/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 or incidents 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 enter only your age, city, state, and chapter affiliation.
Name:

First NameLast Name
Age:
Approximate age is OK - simply name it as such.
Member Organization/Other Organization Affiliation: (if any)
City/State:

Street Address

Street Address Line 2

CityState

Zip Code
Contact phone number:
If this person is under 18, please provide contact information for his/her parent or guardian
Contact Email address:
If this individual is under 18, please provide contact information for parent or guardian
Gender:

MaleFemaleNon-BinaryTransgenderCisgenderPrefer not to answerOther
Reporter 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 NameLast Name
Phone Number:
Please enter a valid phone number.
Email Address:
example@example.com
Member Organization Affiliation: (if any)
Relationship to victim: (if any)

SelfParent/GuardianOther Family MemberFriend or AcquaintanceChapter Member, Coach or VolunteerOther or Prefer not to say
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:
Please verify that you are human*
Should be Empty:

Sport Protection Reporting

Offender Information

Incident Information

Victim Information

Reporter Information

Other Information