Incident Report Form  

 
Contact Information
 
Full Name:
Email:
Phone:
 
Demographic Information
 
Relation to Prairie:
Marital Status:
Gender:
Housing:
 
Incident Details
  I would like to report the the following incident of abuse, harassment or assault.
 
 
Submit Incident Report
 
By submitting this report I verify it to be true. I understand that this report will be sent to a local pastor and professional counselor for accountability. It will also be sent to my Director of Student Development (for students) and the President of Prairie. It will also be automatically sent to a member of the Board of Directors if I have checked that box. In the event of criminal activity, it is your right to contact the RCMP directly and Prairie encourages you to do so. For current abuse, harassment and assault policies, please click here.




 
 

Prairie Bible Institute
Box 4000
Three Hills, AB T0M 2N0
1-800-661-2425

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