Say Something Reporting Form
You can help others by reporting observed threats, behaviors, actions, and harassment. Here are examples of some of the most common behaviors and incidents to report:

Bullying, fighting, harassment or intimidating behaviors
Verbal or physical abuse, assault or harassment
Sexual abuse, assault or harassment
Threats seen on social media
Bragging about weapons or a planned attack
Depression, anxiety or loss of self-controli
Acts of violence, with or without weapons
Hopelessness, excessive guilt or worthlessness
Reckless behavior, theft and petty crimes
Social isolation or withdrawal
Substance or alcohol abuse
Suicide threats, cutting or other self-harm
Any other troubling situation or behavior
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Please provide your name so we can follow up if we need more information.  If you are not a student at Illini Central, please provide a way we can contact you.  Your identity will be protected as much as possible.  If you leave this blank, it will remain anonymous, but by leaving it blank it may be more difficult for us to gather information and provide support.  
If you provide your name and/or contact information, you acknowledge that it will be provided to assist in resolving the concern or threat you are reporting. If you deliberately provide false information or use this system to threaten or harass someone, you may be subject to discipline. *
What's going on? The more information, the better.  (Including... Who, What, Where, When, and How Did You Know?) *
When did or will the event occur? If you don't know exactly, provide as much information as possible. *
Who are you concerned about?  Please provide full name and/or nicknames of individual(s).  If you have contact information for the individual(s) please provide that as well. *
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This form was created inside of Illini Central School District #189. Report Abuse
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