Exit this survey

Question Title

* 1. Your Name (optional):

Question Title

* 2. School Name:

Question Title

* 3. Location of Act:

Question Title

* 4. Date and Time of Act:

Date
Time

Question Title

* 5. Please list in DETAIL the incident:

Question Title

* 6. Please list ALL persons involved:

Question Title

* 7. General Terms: Burrell Anonymous School Safety Tip Line
This is NOT an emergency hotline. If you are reporting an event that could immediately affect your school community, please call 911! This program is intended to facilitate the reporting of sensitive information to school officials, including information regarding student safety, violence, drug use, or students who may be in need of assistance. Reports submitted here will be forwarded electronically to a predetermined list of school officials and, at the school administration's option, to local enforcement agencies. The Burrell School District highly respects and cares for your privacy. We do not collect or store any personal information about you when you submit your anonymous alert tip. Please use the Anonymous Alert program responsibly. Adverse consequences, including serious criminal charges, may result from the submission of a false report. Any unauthorized attempts to upload information or change information on our Anonymous Alert program are strictly prohibited and may be punishable under the Computer Fraud and Abuse Act of 1986 and the National Information Infrastructure Protection Act. I HAVE READ THE GENERAL TERMS AND CERTIFY THAT THE INFORMATION I AM PROVIDING IS ACCURATE TO THE BEST OF MY KNOWLEDGE. I ALSO UNDERSTAND THAT REPORTING A FALSE COMPLAINT IS SUBJECT TO CRIMINAL PROSECUTION.

T