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  1. Anonymous PREA Reporting
    All information submitted are anonymous unless you submit your contact information at the bottom of this form. Providing false or misleading information is a violation of Federal Law and may be subject to prosecution under Title 18 USC 1001. All information is subject to review and verification.
  2. Please enter the victim's name.
  3. Please enter the booking number of the victim.
  4. Please enter the name(s) of the alleged perpetrator(s).
  5. Please enter the witness names. Include other names they may go by.
  6. Please enter the date of the incident you wish to report.
  7. Please enter the time the incident occurred.
  8. Did the incident occur inside the jail?*
    Please select yes or no.
  9. Please enter the specific location of the incident.
  10. Please provide any additional relevant information.
  11. Contact (Optional)
    Please enter your information if you would like to be contacted confidentially by an investigator about your submission.
  12. Leave This Blank:

  13. This field is not part of the form submission.