Threat Form

Go Panthers

Please complete this form to the best of your knowledge so we can assist you. This information will be kept confidential with your administration and school resource officer. Required fields are marked with an asterisk *

Date of incident:*

Answer Required

Date of report:*

Answer Required

Who was the person(s) engaged in the threat(s)?

Answer Required

Grade of person(s) who engaged in threat(s)?

Answer Required

Who was threatened?

Answer Required

What type of threat?

Answer Required

Physical

Emotional/Social

Damage to Property

Online

Other:

Other location details: (Please explain the specific location details such as which hallway, where on the internet, what restroom, etc.

Answer Required

Describe what happened with as many details as possible.

Answer Required

Person reporting the incident: (Optional). Please use your full name.

Answer Required

May we contact you for more information on this incident?

Answer Required

Yes

I certify that this information is accurate to the best of my knowledge.*

Answer Required

Yes

Thank you for reporting this incident. We appreciate your concern. When you click "Submit" this will be sent to the campus administrator.

Clarksville High School

Please fix the highlighted areas below before submitting.

Threat Form