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Online Child Abuse Neglect Reporting
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Tell us about the child you are concerned about
Tell us about the child you are concerned about
Name Unknown?
First Name
Middle Name
Last Name
Suffix
Date Of Birth
Age (years)
Age (months)
Gender
Select Gender
Female
Male
Unknown
Race
Select Race
Asian
Black / African American
Declined To Identify
Native American / Alaskan
Native Hawaiian / Pacific Islander
Unknown
Unknown Due To Abandonment
White
Ethnicity
Select Ethnicity
Declined to Identify
Hispanic Central American
Hispanic Cuban
Hispanic Dominican
Hispanic Mexican
Hispanic Other
Hispanic Puerto Rican
Hispanic South American
Hispanic Spanish Descent
Not Hispanic
Unknown
Unknown Due To Abandonment
Other Race
Select Other Race
Asian
Black / African American
Declined To Identify
Native American / Alaskan
Native Hawaiian / Pacific Islander
Unknown
Unknown Due To Abandonment
White
Language
Select Language
Albanian
Arabic
Armenian
Bengali
Bulgarian
Cantonese
Chinese
Croatian
Czech
Danish
Dutch
English
Flemish
French
German
Greek
Hebrew
Hindi
Icelandic
Iranian
Italian
Japanese
Khmer
Korean
Lao
Latvian
Lithuanian
Malay-Indo
Nonverbal
Norwegian
Other
Persian
Polish
Portuguese
Punjabi
Romanian
Russian
Serbian
Serbo-Croatian
Sign Language
Slovak
Slovenian
Spanish
Swahili
Swedish
Tagalog
Tamil
Thai
Ukrainian
Unknown
Urdu (P&I)
Vietnamese
Yoruba
Do you know child's primary address?
Do you know child's primary address?
Yes
No
Select country
Please select
United States
Street
Street
City
State
Zip
Is the child currently at their primary address?
Is the child currently at their primary address?
Yes
No
Unknown
Do you know the child's current location?
Do you know the child's current location?
Yes
No
Child's Current Location
Street
Street
City
State
Zip
Does the child have a phone?
Does the child have a phone?
Yes
No
Unknown
Phone Type
Select Phone Type
Home
Fax
Personal Cell
Pager
Work
Alternative
Work Cell
Phone Number
Is this child an active military dependent?
Is this child an active military dependent?
Yes
No
Unknown
Military Branch
Select Military Branch
Air Force
Army
Coast Guard
Marine Corps
National Guard
Navy
Space Force
Unknown
Military Base
Are there any other names the child goes by?
Are there any other names the child goes by?
Yes
No
Unknown
Alias Type
Select Alias Type
Former Married Name
Legal Name
Maiden Name
Nickname
Other
Street/Gang Name
Alias First Name
Alias Middle Name
Alias Last Name
Do you have knowledge of how the child functions on a daily basis, socially, emotionally, physically, and cognitively?
Do you have knowledge of how the child functions on a daily basis, socially, emotionally, physically, and cognitively?
Yes
No
Unknown
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