Forms

Edit the public intake form and both C-SSRS screener instruments. Branching rules and a live preview update as you edit; publishing creates a new version.

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Public Intake Form (Report a Concern)

Version 4 · published Jul 1, 2026 by Dana Whitfield

1
What type of concern are you reporting? *
select4 options
2
Which school is involved? *
select1 options
3
Date of incident (optional)
date
4
People involved (name + role)
repeatable
5
Describe what happened *
textarea
6
Your relationship to the student
select4 options
7
Your email (required unless anonymous)
text
8
Submit anonymously
yes_no

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Exactly what a respondent sees

Public Intake Form (Report a Concern) · v4

1.What type of concern are you reporting? *
2.Which school is involved? *
3.Date of incident (optional)
4.People involved (name + role)
+ Add entry (name + role)
5.Describe what happened *
6.Your relationship to the student
7.Your email (required unless anonymous)
8.Submit anonymously

Answer a branching yes/no question above to see its conditional items reveal in real time.