Report Abuse Form

Select the allegation(s) against an NWRRC resident (Please check the appropriate box or boxes): *

Sexual Harassment

Sexual Abuse

Sexual Assault

Your Name (optional)

Your Email (optional)

Resident (victim) Name: *

Perpetrator Name, if known:

Is the perpetrator also a resident at NWRRC? *

Yes

No

Unknown

Your relationship to the resident (victim): *

If Other, please specify:

List the name(s) of all parties who were involved, and how they are connected to the resident: *

Have legal actions been taken (or will be taken) in this matter? *

Yes

No

Describe the nature of the allegation as follows (select one): *

Staff Against Resident

Resident Against Staff

Resident Against Resident

Date(s): *

Time(s) *

Location (if known)

How did you learn about the alleged action(s)? *

If Other please specify:

In your own words, what happened: *

Upon submitting this Form, this information will be reviewed by the agency PREA Coordinator. If you need to make an inquiry regarding your submission, you can reach them directly at: (503) 445-8178. *

I Understand

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