DSUSA Sport Protection Reporting Offender InformationThis section is about the individual you are reporting. Please provide as much information as possible.Name of Individual that you are reporting *FirstLastGenderMaleFemaleAddressAddress Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePosition(s) this individual holds or held:EmployeeVolunteerOther/Not SureOrganization where individual works and/or volunteers or worked/volunteersIncident InformationThis section asks questions about the incident or incidents you are reporting. Please provide as much specific information as you are able.Type of Offense (i.e. what happened?)Where did the incident(s) take place?Please describe what happened? (including who, what, when, where) Victim InformationThis section is for information about the victim or victims. If you are the victim and wish to remain anonymous, you may do so. In that case, please enter only your age, city, state, and chapter affiliation.Victim's Name *FirstLastVictim's Age (or approximate age)Victim's phone number (if this person is under 18, please provide the parent or guardian's phone numberVictim's email (if this person is under 18, please provide the parent or guardian's email address)Reporter's InformationYou may remain anonymous if you wish. However, providing your information is vastly helpful to a swift and effective investigation. A person reporting alleged misconduct should not fear any retribution and/or consequence when filing a report he or she believes to be true.Reporter's Name *FirstLastReporter's PhoneReporter's Email *Relationship to victime (if any)SelfParent / GuardianOther Family MemberFriend or AcquaintanceChapter Member, Coach, or VolunteerOther or Prefer not to sayCommentSubmit
