Student Injury Report Form

Student Injury Statement Form

Complete this form within 48 hours of incident.

  • MM slash DD slash YYYY
  • :
  • MM slash DD slash YYYY
  • Be as specific as possible.
  • Be specific and detailed.
  • Be as detailed as possible.
  • List anyone who may have witnessed to accident/incident.
  • Drop files here or
    Max. file size: 49 MB.

    • By submitting this form electronically, you are giving consent to use this as acknowledgement of your electronic signature.

      This will be utilized in place of your handwritten signature.