Report And Protect Salina

Are you a victim or third party?

Third Party

Victim

Was the victim a minor at the time this occurred?

Yes

Do you wish to remain anonymous?

Yes

First Name

Last Name

Email Address

Phone

Date of Abuse or Start Date

End date (if applicable)

Archdiocese or diocese *

The archdiocese or diocese to which you currently belong

Incident location *

Begin typing location name, city, state or zip code

(If you are still have trouble finding your location, please type 'other')

Please tell us more about: Incident location - Other

Incident location name *

Incident city and state *

Abuse perpetrator and title

Please describe the incident in detail *

Please provide victim or multiple victim names here as applicable

If a report has been made previously, please provide the agency or name of person (their position, etc.)

If you wish to be contacted, please provide the best method and time to be contacted

Special circumstances you'd like known before contact

Would you like counseling services? *

Yes