Child Abuse Survey 15-16

Enter number of reported cases of Suspected Child Abuse.

DEADLINE: October 28, 2016

Please submit any data you may have for the 2015-2016 school year:

Question Title

* 1. School District Name

Question Title

* 2. Type of District

ESD

USD

HSD

LACOE Sites

Question Title

* 3. Person Filing Report

Name:

Title:

Email Address:

Phone Number:

Question Title

* 4. Does your district collect data on suspected child abuse reports?

Yes

Yes, we collect data, but we currently do not have any data.

No, skip to question #13

For each school level, enter the number of suspected child abuse reports made.

Question Title

* 5. Preschools

Sexual Assault

Physical Abuse

General Neglect

Emotional Abuse

Question Title

* 6. Elementary Schools

Sexual Assault

Physical Abuse

General Neglect

Emotional Abuse

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* 7. Middle/Junior High Schools

Sexual Assault

Physical Abuse

General Neglect

Emotional Abuse

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* 8. High Schools

Sexual Assault

Physical Abuse

General Neglect

Emotional Abuse

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* 9. Other type schools: (please specify)

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* 10. Other type schools

Sexual Assault

Physical Abuse

General Neglect

Emotional Abuse

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* 11. Enter the ethnicities for the total number of District suspected child abuse reports made

African American

Caucasian

Native American

Hispanic (Non-White)

Pacific Islander

Asian

Unknown

Other (please specify in #12)

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* 12. List other ethnicities and district count related to question #11.

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* 13. Reason for not collecting data: (Please check all that apply)

Our legal counsel advised against collecting data

Concerns with breach of confidentiality

It is not required by law