Vaping Report Form
District Vaping Responses 2023-2024

This form should be utilized to report a vaping offense. 

Please fill out all fields below and hit submit.  

Should you have any questions, please reach out to the SAC Department supervisor, Ms. Laurel Olson, at 973-321-0694 or lolson@paterson.k12.nj.us

PLEASE NOTE - Once this report is completed, the vaping device should be given to your Building Administrator for disposal.
Email *
Date of Incident  *
MM
/
DD
/
YYYY
Your Name *
Student Name *
Student ID# *
Student's School *
Grade Level  *
Student's Gender *
Student's Race  *
Special Ed *
Drug test conducted? *
Please choose the type of vaping device using the examples below. *
Captionless Image
IMPORTANT! If you are in possession of Type B, you must also complete a substance abuse referral. ( https://forms.gle/U8cENqdAckHJf1mdA) 
 *
Will the student be suspended for the possession? *
If YES, what type of suspension? *
If suspended, how many days?
Are there any additional comments you'd like to share about this incident?
A copy of your responses will be emailed to .
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