Gang-Related Incident
Reporting Form
Office of Student and Family Support and Engagement
MONTGOMERY COUNTY PUBLIC SCHOOLS • Rockville, Maryland 20850
This form is to be confidentially maintained in accordance with the Family Educational Rights and Privacy Act, 20 U.S.C. § 1232g.
DISTRIBUTION: School Confidential File
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, at school-sponsored events, or on the way to/from school.
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 by 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 Annotated Code of Maryland §11-154 of the Transportation
Article; or (2) in, or within 1,000 feet of real property owned or leased to an elementary school, secondary school, or Montgomery
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 _______________________________________________________________________________
Person Reporting Incident: Name
Telephone - - E-mail
Place a ✓ in the appropriate box:
□ Student Victim □ Student (witness/bystander) □ Parent/guardian □ School staff member □ Bystander
□ Other __________________________________________________________________________________________________________
Name(s) of student victim(s) (Please print) Age Grade School (if known)
Name(s) of alleged offender(s) (If known) (Please print) Age School (if known) Is alleged offender
a student?
□ Yes □ No
□ Yes □ No
□ Yes □ No
Name(s) of alleged witness(es) (If known) (Please print) Age School (if known) Is alleged witness a
student?
□ Yes □ No
□ Yes □ No
□ Yes □ No
MCPS Form 230-37
August 2016
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