Ashtabula County Children's Services Documentation Form

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Please complete this form any time you have to call and report suspected abuse to Child Services. Before you end the call with the representative, please request a letter to confirm your conversation. You may have it sent to the school to protect your privacy. The address for GMS is 839 Sherman Street, Geneva OH 44041.

Student's Last Name *

Student's First Name *

Grade *

First and Last name of adult reporting the incident *

Description of incident (be specific and include any details important to the situation) *

Name of person you spoke to at Children's Services *

Does this child have special needs? *

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This form was created inside of Geneva Area City Schools. Report Abuse

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