MPSHome Alumni Calendar Contact MyMPS
Patrick Henry High School 4320 Newton Avenue North, Minneapolis., MN 5412 (612) 668-2000
Incident Offense:
Date Occurred: 
Please give your best estimate of when the incident occurred, for example 8:00 - 11:00 AM
Time Occurred: 
Officer Taking Report  
VICTIM
Name: 
Student ID #: 
Email: 
Grade 
Home Address: 
Phone 
Schedule: Please list teacher's last name.
Period 1 
Period 2 
Period 3 
Period 4 
Period 5 
Period 6 
Period 7 
WITNESS 1
Name 
Grade 
WITNESS 2
Name 
Grade 
WITNESS 3
Name 
Grade 
SUSPECT 1
Name 
Grade 
SUSPECT 2
Name 
Grade 
SUSPECT 3
Name: 
Grade 
LOSS: Please describe in as much detail as possible the quantity, type of item (s) and value of each item.
Lost items, quantity and total value of each item.