CLEARFIELD AREA MIDDLE SCHOOL
 THEFT REPORT FORM

ANY FALSE REPORTS WILL RESULT IN DISCIPLINARY ACTION EITHER BY THE SCHOOL AND/OR POSSIBLY THE SCHOOL RESOURCE OFFICER

Student filing complaint:
 
Grade:
 
Homeroom Teacher:
 
What was taken from you:
 
Who took these items:
 
What date did this incident take place:
 
What time did this incident take place:
 
Has this person taken from you before:
 
Witnesses to this incident:
 
Where were these things when they were taken from you:
 
What time of the day (class period, in-between classes, etc.):
 
Whom have you told about this incident:
 
Is there anything else you would like to add to this report: