2023-24 KIPP Newark Anonymous School Threat Reporting Form

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This form is intended to anonymously report a school threat, in accordance with New Jersey state guidance. If you do NOT wish to be anonymous, please contact the school's principal directly. A list of contacts can be found HERE (choose the location Newark/Camden and the grade level that applies).

Types of behaviors to report:

❏ Threats of violence (verbal and non-verbal)

❏ Behaviors involving weapon carrying or menacing actions

The process is designed for assessment of threats to harm others and is not intended for individuals who have only threatened to harm themselves.

Name(s) of student(s) believed to have made a threat of violence or exhibited behaviors involving a weapon/menacing action(s): *

Name(s) of potential witnesses: (if known)

Approximate Date of Incident: (if known)

YYYY

Location of alleged incident(s):
*

Description of incident(s). Be as specific as possible:
*

This report is based on the following evidence (choose as many as apply):

I have witnessed the threat myself

I have physical evidence of the threat (digital or paper)

The student who exhibited a threat of violence reported it to me

I heard about it from someone else or overheard people talking about it

Required

IF you have physical evidence, please send promptly to school administration, a list of contacts can be found HERE

I certify that the information on this form is accurate and true to the best of my knowledge and belief; my digital timestamp below serves as my anonymous signature.
*

Time

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