SUSPECTED CHILD ABUSE REPORTING FORM

Date Sent SUSPECTED CHILD ABUSE REPORTING FORM Grand Prairie Independent School District Today’s Date Send the original report to: Coordinator of Health Services (in a sealed envelope marked confidential) Grand Prairie ISD Education Center and one copy to either DFPS and/or GPPD Texas Department of Family And Protective Services PO Box 200697 Arlington, Texas 76006-0697 1-800-252-5400 Student’s Name: Student’s Address: Date of Birth: School (full name): Name of Mother or Guardian: Address (if different from student’s): Siblings? YES NO If YES, how many? Siblings’ names and ages: Work Number: Home Phone: Grand Prairie Police Department Criminal Investigation Unit 801 Conover Grand Prairie, Texas 75051 911 Called (If emergency) (972) 237-8700 Ethnicity: Describe basis for suspicion of child abuse; describe injuries and how injuries were sustained: Please list others who were notified: Case Worker’s Name: Police Officer’s Name: Name of Reporting Person (not required): Contact Phone Number (not required): PSS0805 Case Number Assigned: Service/Badge Number: