Reaching Others University at Buffalo - The State University of New York
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Suspected Child Abuse Report Form

Information About the Incident

 
 
Include whether a.m. or p.m.
 
 
 
 
 
 

Check all that apply

 
Be as specific and detailed as possible to the best of your recollection.

Information About the Victim(s)

 
 
Appoximate age if unknown

Information About the Abuser

 

Information About Additional Witnesses

 
 
 
 
 
 
 

Who Have You Shared This Experience With So Far?

 
 
 
 
 
 

CONFIDENTIALTY STATEMENT

The Office of Equity, Diversity & Inclusion and University Police will make every effort to maintain confidentiality except in situations where law, University policy, or the investigatory process requires the release of information.

Providing your name and contact information is optional. If you choose to provide this information, it will assist with an investigation and follow-through. Each complaint will be investigated to the best of the University’s ability, based upon the information provided.

Retaliation against an individual who reports suspected child abuse/inappropriate conduct is strictly prohibited.

Information About You (the person filing this report)--optional