Abuse Reporting

Abuse reporting & concerns should be submitted below. Additional concerns can be directed to Executive Director, Melissa Zielinski, at mzielinski@wiyouthsoccer.com.

Reporter Information

Reporter First Name

Phone

Reporter RoleAthleteClub AdministratorClub BoardCoachGuardianMedical/TrainerMinor AthleteMinor CoachRefereeVolunteerOtherPrefer not to answer

Reporter Last Name

Email

Incident Information

Did this occur over multiple days? *

• Yes
• No

Date of Incident (start/only)

Date of Incident (end)

Incident TypeAbuse against a RefereeBullyingEmotional MisconductHarassmentHazingMAAPP ViolationPhysical MisconductReferee MisconductRetaliationSexual MisconductViolation of WYSA PolicyI’m not sure, I just know I have a concern to report

Location of Incident

Incident Details *

Providing as much detailed information as possible will greatly assist the investigation process

Does this report involve allegations or concerns of sexual misconduct? *

• Yes
• No

Does this report involve allegations or concerns of child abuse or child sexual misconduct? *

• Yes
• No

Involved Parties

DropdownClaimant (Victim)Respondent (Accused)Other

First Name

Phone Number

Date of Birth Known? *

• Yes
• No

Is this person a minor or adult? (if birthdate unknown)

• Adult
• Minor
• Unknown

Last Name

Email Address

Date of Birth (if known)

Additional Parties Involved

Providing as much detailed information as possible will greatly assist the investigation process

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