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2. Newport News Department of Juvenile Services will investigate all allegations of sexual abuse, sexual misconduct, harassment and retaliation by any resident, volunteer, contractor, professional resident or staff member upon receipt of this form. It is the intention of this department to ensure that everyone conduct themselves in an appropriate manner at all times. This form is a pre-requisite to the investigation of any allegation of sexual abuse, sexual misconduct, harassment or retaliation reported though a third party.

   
   

   You can either complete this form online or print and mail to:

   PREA Manager
   350 25th Street
   Newport News, VA 23607
4. Complainant's First Name*
5. Complainant's Last Name*
7. Street Address*
9. City*
10. State*
    -- Select One --AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming
11. Zip Code*
13. Name of the resident(s)*
15. Name of the person(s) involved*
17. Name(s) of any witnesses
19. Date of the incident*
    Date of the incident
21. Location of the incident*
23. Description of the incident*
25. Any additional relevant information
Leave This Blank:


27. 1. Receive an email copy of this form.
28. Email address

    This field is not part of the form submission.

29. Submit Submit and Print

* indicates a required field