West Rapids Elementary Wellness Tip Line

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If you have a concern regarding a student's wellness: mental health, chemical use, social isolation, bullying, harassment, etc. and would like to report this information, please complete the following items to the best of your knowledge. You may also report your concern in person to an administrator, counselor or other school staff.

Please note that this form can be submitted anonymously. However, the more information you provide the better we are able to investigate and support the student regarding your concern.

Knowingly making a false report is a violation of school policy.

All submissions will be taken seriously and addressed during school hours.

Note: This is not a crisis line. Please note that reports received during the summer may not be addressed in a timely manner.

IF THIS IS AN EMERGENCY, CALL 911

IF YOU ARE IN NEED OF CRISIS, CALL 211 OR TEXT "MN" TO 741741

Incident Report

Please describe your concerns in as much detail as possible: *

Please include name(s) of the individual(s) involved:

Indicate the grade(s) of the individual(s): *

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th Grade

5th Grade

Unknown

Required

Location of Incident:

Bathroom

Classroom

Hallway

Lunchroom

Offcampus

Parking Lot

Playground

Other:

Date and time of incident

YYYY

Time

If you know of other witnesses, please include their names below:

Contact Information

Most of the following information is encouraged but not required. The more information you are able to provide, the better we are able to investigate and support the student regarding your concern.

Reporter

Student

Family Member

Other:

Clear selection

Name:

Phone Number:

Email Address:

I would like to be contacted for a follow-up: *

Not at this time.

I have included my contact information and would like to receive a follow-up call or email

This information will be used to provide a safe, supportive environment for our students. The information will be used to help students with any issues/concerns that are raised. Information may be shared with educators who have a need to know in order to help support our students or with outside agencies who are required to be alerted or who may assist students as well. You are not under any obligation to provide information but we encourage you to provide information that may help students have a safe, productive educational environment.

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