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1. Name (optional)

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2. Phone Number (optional)

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3. Email (optional)

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4. Preferred Contact Method

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5. Your Affiliation (check all that apply) (Required.)

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6. How many different incidents are you reporting

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7. Incident Date(s) and Time(s)

Date
Time
Date
Time
Date
Time
Date
Time
Date
Time

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8. Incident Location(s)

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9. Type of Incident (check all that apply)

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10. Basis for Report (were you targeted because of) (check all that apply)

                                                                                                                                                                

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11. Offender(s) (name of person who harmed you)

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12. Affiliation (check all that apply)

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13. Phone Number

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14. Email

Please provide details here of people who witnessed or know of the harm you experienced:

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15. Witness 1

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16. Witness 1 Affiliation (check all that apply)

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17. Witness 1 Phone Number

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18. Witness 1  E-mail

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19. Witness 2

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20. Witness 2 Affiliation (check all that apply)

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21. Witness 2 Phone Number

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22. Witness 2 E-mail

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23. Witness 3

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24. Witness 3 Affiliation (check all that apply)

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25. Witness 3 Phone Number

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26. Witness 3 E-mail

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27. More Witnesses?

                                                                                                                                                                

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28. Incident Narrative (this can be brief; a full statement will be taken by the investigator)

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29. Supportive Measures Requested (check all that may apply):

                                                                                                                                                                

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30. Accommodations

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31. Resolution Requested (Required.)

  • TNG, a third-party professional investigation service, will follow-up on any reports made using this form. TNG is seeking first-hand reports by those impacted/harmed while participating in the A.R.E. Camp program. Those reports will be diligently investigated if the harmed party so wishes. Information from third-parties is helpful and encouraged, but TNG cannot guarantee that all third-party information will be acted upon, directly.
    TNG will maintain the confidentiality of all information shared during the investigation process to the extent permitted by law.
  • If this form is completed anonymously, and no personally identifiable details are provided, TNG will be limited in the actions it can take but will inform A.R.E. Of the need to address the type of misconduct identified on this form, generally.
    If a formal investigation is requested, TNG will follow-up with you to do so. That investigation will result in findings, and can result in A.R.E camp-based remedies.
  • TNG can make or assist in referrals to law enforcement, if requested by you.
    TNG will follow all child/elder/disability abuse reporting requirements of applicable law.
  • If you prefer to contact TNG by telephone, please use this number: (267) 607-3654, which is staffed during regular business hours (et), Monday-friday. You may leave a voicemail.
    If you are in an emergency health/safety situation, please do not leave voicemail, but immediately contact 911.

If you have provided an email address, you will receive an immediate auto-response from TNG confirming this submission was received via email. Then, you will receive a personalized response from a TNG investigator (using your preferred contact method) within 48 hours of submission (except weekends/holidays).

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32. Affirmation (Required.)

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