Insert Tip

School Name:

1. Choose the school involved in this report. (If you do not find your school, please contact the MO School Violence Hotline at 1-866-748-7047. Please report that your school was not found, so it can be added to the list.)

(This is Required information)*

SCHOOL DATABASE, PRIVATE AND PUBLIC SCHOOLS

Find a School
Enter any word of the school name.

Or
Enter city to locate school.

2. Policy agreement must be checked before proceeding.

TERMS OF USE:

If this is an emergency, please call 9-1-1. This public service is not for emergencies that require immediate attention.

If you wish to report anonymously, do not provide any information about yourself. All information provided about the school violence incident will be forwarded to the local school district and the local law enforcement agency with jurisdiction during regular program hours (M-F, 7AM-6PM). The hotline does not assume responsibility for how or when the information is acted upon by school officials or local law enforcement.

On-line reports are taken very seriously. False reporting may be prosecuted.

By clicking on the "Submit" button, you are confirming that you have read, understood, and agreed to the Terms of Use and the attached Privacy Policy.

I have read and agreed to the TERMS OF USE and the Privacy Policy.

***Required***

3. What type of school violence are you reporting today?

(Required information)

Assault or Fighting	Other Weapon:
Bullying	Property Destruction
Cyber-Harassment	Sexual Misconduct
Explosives	Suicide Threats
Gangs	Theft
Guns	Threats
Harassment	Other:
Knives



Test(Office Use)

4. Choose to remain anonymous or choose to leave your name to be shared with the school and law enforcement:

Anonymous (Choose if you do not want to give your name. Select this if you do not want to give your name.)
Share my name with the School and Law Enforcement: (Optional) Select this if you want to give your name to the school and law enforcement.
Last Name Enter last name here if you choose to share your name.	First Name
Street Address
City	State	Zip
Phone
Email

5. How would you describe yourself? (Optional)

Student

Parent

Concerned Citizen

School Staff

Law Enforcement

Other

6. Please identify the suspects or aggressors of the school violence.

Suspects Person hurting or intending harm on others.

Person hurting or intending harm on others.

Last Name

First Name

Age

Select a Number (5-18)

DOB

Male

Female

Street Address

City

State

Zip Code

Phone

School name, if different than above.

Grade

Race

Added Information: (like hair color and style, scars, marks, tattoos, glasses, height, weight, clothing, vehicle, or gang affiliation)

Information

(Max 325 characters)

7. Please identify the victims or targets of the school violence.

Victims Person who was hurt or threatened.

Person who was hurt or threatened.

Last Name

First Name

Age

Select a Number (5-18)

DOB

Male

Female

Street Address

City

State

Zip Code

Phone

School name, if different than above.

Grade

Race

Added Information: (like hair color and style, scars, marks, tattoos, glasses, height, weight, clothing, vehicle, or gang affiliation)

Information

(Max 325 characters)

8. Please describe in detail the school violence concern or threat.

Detail of Incident
When did the incident happen? Date (Enter:mmddyyyy or mmddyy Example:01012009 or 090109)	Approximate Time	AM (Morning) PM (Afternoon)
Class	Before School During School After School Other

Where did the incident happen (on which bus, in which classroom, at which school event, in which school parking lot...)?
Bus #	Class Room
School Event	Other
What happened (please describe)?
Description (Max 2500 characters)
Who witnessed or saw the incident (list any witnesses)?
Name(s) or Description (Max 325 characters)
Has this happened before? Yes No

9. Have you already reported the incident; if so, to whom and when?

Name(s), Date, and Description

(Max 325 characters)

10. How did you hear of the MO School Violence Hotline? (Optional)

Pencil	School Staff	Other
Poster	Magnet