PREA Reporting Page – DCDC PREA Agency

PREA Incident Report Form

If you would like to report an incident of sexual assault, sexual abuse or sexual harassment involving a resident of CSYC, WNRYC or Juvenile Detention, please complete and submit the following form.

If you would like to be contacted, please provide your contact information at the bottom of the form. If you do not submit your contact information, your report will be submitted anonymously.

Resident's Name

Resident's ID Number (if known):

Type of Incident (chck all that apply):

Details:

Where did the Incident Occur?

Incident Date:

Reporters Contact Information (Optional)

If you would like to be contacted. Please provide your information in the fields below. If you do not wish to submit this information, your information will be submitted anonymously.

Name:

Address:

Phone Number:

Email:

DCDC PREA Agency

PREA Incident Report Form

Reporters Contact Information (Optional)

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