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SPORT PROTECTION REPORTING
Offender Information:
This section is about the individual you are reporting. Please provide as much information as possible.
Name of the Individual you are reporting:
*
Offender's Street Address
Offender's City
Offender's State
Gender of Individual
*
Male
Female
Other
Organization where this individual works or volunteers currently or has in the past:
Position(s) this individual holds or held:
Instructor/ Coach
Assistant
Employee
Volunteer
Family Member
Community Member
Other/Not Sure
Incident Information:
This section asks questions about the incident or incidents you are reporting. Please provide as much specific information as you are able.
Type of Offense (i.e. what happened?):
*
Where did the incident or incidents take place? (City, State and any other available location information)
*
Please Describe what happened: (Including... Who, What, When, Where)
*
Victim Information:
This section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state.
Name
Age (or approximate age):
*
City
*
State/Province
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
American Samoa
Federated States of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
U.S. Minor Outlying Islands
Virgin Islands
Armed Forces Americas
Armed Forces Europe, the Middle East, an
Armed Forces Pacific
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavat Territory
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon Territory
Gender
Male
Female
Other
Contact phone number:
(Note, if this individual is under 18, please provide contact information for parent or guardian)
Contact Email address:
(Note, if this individual is under 18, please provide contact information for parent or guardian)
Reporter Information:
You may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she believes to be true.
Reporter Name
Relationship to Victim (if any)
Parent/ Guardian
Other Family Member
Friend or Acquaintance
OAS Instructor
OAS Assistant
Other or Prefer not to say
Phone Number
Email Address
Other Information:
If you have any other information that you feel would be helpful to an investigation of the alleged offense you have reported, please enter it here.
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