DSES Sport Protection Reporting
DSES strongly encourages the reporting of misconduct and
appreciates your willingness to report inappropriate behavior.
Offender Information
This section is about the individual you are reporting. Please provide as much information as possible.
Name of Individual That You are Reporting
:
First Name:
Last Name:
Gender:
Male
Female
Address:
Street:
City:
State/Province/Region:
Position(s) this Individual Holds or Held:
Please select...
Head Coach/Instructor
Assistant Coach
Employee
Volunteer
Other/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, etc.):
Where did the Incident or Incidents Take Place? (Including Who, What, When and Where)
:
Please Describe What Happened (Including Who, What, When and 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.
First Name:
Last Name:
Age (or Approximate Age):
Chapter/Organizational Affiliation (If Any):
Contact Phone Number (Note: If this individual is under the age of 18, please provide contact information for their parent or guardian):
Contact Email Address (Note: If this individual is under the age of 18, please provide contact information for their parent or guardian):
Gender:
Male
Female
Reporter's 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.
First Name:
Last Name:
Phone Number:
Email Address:
Chapter Affiliation (if any):
Relationship to Victim (If Any):
Please select...
Self
Parent/Guardian
Other Family Member
Friend or Acquaintance
Chapter Member, Coach or Volunteer
Other 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:
Contact Information