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Office of Child and Youth Protection

 

 


Reporting Suspected Abuse

Diocese of Metuchen, NJ complaint form for allegations of sexual abuse and/or child abuse of a minor

This form may be used to present an allegation that a Diocesan Clergy Member, Employee or Volunteer has committed an act of sexual abuse and / or child abuse of a minor. The completed form is CONFIDENTIAL and is to be submitted via email.

1. INFORMATION AS TO THE COMPLAINANT
Name
Address
City    
State Zip
Date of Birth Telephone
E-mail
Name and Address of Parent(s) or Guardian (if complainant is a minor)
Name of School (if complainant is a minor)
2. INFORMATION AS TO ACCUSED
Name

 

Offender's profession:

 Clergy Deacon Religious
Other (please describe)
Parish / Place of employment

Has the accused been confronted or informed of allegation?

 Yes No
If Yes, when and by whom?
3. INFORMATION AS TO ALLEGATIONS
Brief description of alleged abuse (time, place, and acts):

Have the allegations been reported to any civil authorities or Church personnel?

 Yes No
If yes, when, how, and to whom:
Date of Report      
Person reporting:    
Name    
Address    
City State
Zip Telephone
 





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