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Erinís Law Referral Form



Erinís Law is a state mandated, age appropriate sexual abuse and assault awareness and prevention education program for students Pre-K through 12th grade. Erinís Law requires that children be educated by law in schools on sexual abuse in a child friendly manner, for the purpose of informing and protecting students from sexual abuse. Warning signs of abuse include, but not limited to, the following: prolonged depression or withdrawal from family and peers, displays knowledge or interest in sexual acts that are inappropriate for his/her age, makes strong efforts to avoid a specific person without an obvious reason, runs away from home, signs of physical discomfort, aggressive behavior towards others, and mistreatment of animals and other children.

To report a sexual abused situation as described above, please complete the ďErinís Law Referral FormĒ below and submit. Hickory Creek Middle School appreciates your communication and support in ensuring the safety and welfare of all students.

Name:
Phone:
Email:
Are you a:
Please indicate the grade of the student(s) involved:
Please provide the student(s) names if known:
When did the incident occur:
Please provide a specific date if known:
Where did the incident occur:

Please describe the sexual abused incident (include as much as you know):


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