Gang-Related Incident Reporting Form
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Directions: This is a form to report alleged gang activity and similar destructive or illegal group behavior or to report reprisal or retaliation against individuals who
report gang activity and similar destructive or illegal group behavior or who are victims, witnesses, bystanders, or others with reliable information about an act of
gang activity and similar destructive or illegal group behavior which occurred on school property, on school buses, or at school-sponsored events.
Gang: “Criminal Gang” means a group or association of three or more persons whose members:
(1) individually or collectively engage in a pattern of criminal gang activity;
(2) have as one of their primary objectives or activities the commission of one or more underlying crimes, including acts by juveniles that would be
underlying crimes if committed adults; and
(3) have in common an overt or covert organizational or command structure.
Gang Activity: “Pattern of criminal gang activity” means the commission of, attempted commission of, conspiracy to commit, or solicitation of two or
more underlying crimes or acts by a juvenile that would be an underlying crime if committed by an adult.
(a) Activities on or near school vehicles or property. – A person may not threaten an individual, or a friend or family member of an individual with use
of physical force or violence to coerce, induce, or solicit the individual to participate in or prevent the individual from leaving a criminal gang: (1) in a
school vehicle, as defined under §11-154 of the Transportation Article; or (2) in, or within 1,00 feet of real property owned or leased to an elementary
school, secondary school, or county board of education and used for elementary or secondary education.
(b) Applicability. – Subsection (a) of this section applies whether or not : (1) school was in session at the time of the crime; or (2) the real property
was being used for purposes other than school purposes at the time of the crime.
Today’s date: _________ / _________ / ___________
School: ___________________________________
Month
Day
Year
School System: ______________________________
P
R
I
Name: __________________________________________
ERSON
EPORTING
NCIDENT
Telephone: ___________________________
E-mail: _________________________________________
Place an X in the appropriate box: Student Student (Witness/Bystander) School Staff
Other_______________________________________________________________________
1. Name of student victim: ____________________________________________________ Age: _________
(Please print)
2. Name(s) of alleged offender(s) (If known):
Age
School
(Please print)
Is he/she a student?
(if known)
___________________________________________
_______ _______________________
Yes No
___________________________________________
_______ _______________________
Yes No
___________________________________________
_______ _______________________
Yes No
3. On what date(s) did the incident happen?
_______ / ________/ _________
_______ / _______ / ________
_______ / ________/ _________
Month
Day
Year
Month
Day
Year
Month
Day
Year
4. Please describe what occurred:
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
_____________________________________________________________________________________________
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