JKMS Student Statement
Please use this form to let us know what is going on. You may submit this report anonymously.  If you submit the form anonymously, we will not be able to meet with you to discuss your statement.
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What is your First and Last Name? If you would like to make an anonymous report, then write the word "Anonymous" as your first name.
What is your student ID number (your lunch number)?  Leave this blank if you want to make an anonymous statement.
What happened? *
Were there any other kids with you? If so, who? *
When did this happen? *
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DD
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Where did this happen?
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