Child Protection Violation Form

Details of the Complainant

Name

Phone number

Email ID

Please use your Teach For India email id if you’re a Fellow, Staff, Alumni, Intern

I am

Place of Work

Nature of the Complainant's association or relationship with the alleged victim

Details of the Alleged victim

Number of Students

Name of the alleged victim(s)

Gender

Age

City

Educational Institute

Class/Grade

Name of the Parents/Guardian

Address of the Parents/Guardian

Phone number of the Parents/Guardian

Details of the Incident

Nature of the Incident

Description of the Incident

Location of the Incident

Frequency the Incident

Date of the Incident

Name of the alleged offender

Association of the alleged offender with Teach For India

Names of the witnesses of the Incident

Signature

write your name

Date

Place