QI UTI od cae SUSPECTED CHILD ABUSE REPORT __ Reset Form To Be Completed by Mandated Child Abuse Reporters. Pursuant to Penal Code Section 11166 ‘CASE NAME: PLEASE PRINT OR TYPE CASENUMBER: EN ones aay | Teeekor . SE MOE Pale Scbals 2315 34 St. See asialn (ie) ) 452-8342 ee ___ REPORTING PARTY. BB |rcommevasioscemecrn Po gs |" oe a te ~ OATEFTIME GF BHM GALL Be ae ——— = “3 z - - won & & | siisicniv oases evetoanainmnr atone SE lives Aw (aves Ax OE Pirosrencante fe § | aves TAvcARE YOULDEME CENTER TrOStERramr HOME —W¥aMRy RENO gg). = ‘ — a [ime paar pret oT — Bane ORR RSE e —— ee = si —siowe Bowe "BDBINERS BNE ag =D oe ‘noe. Ey 3 al Essense aia i a ie - gs = — —— VATA ENTRASHEETSV OROMERTORM MOOR SHO Gare nc na “A Sacraments Ugh Schaal E, INCIDENT INFORMATION ‘SBaST 2h wo DEFINITIONS AND INSTRUCTIONS ON REVERSE BO NOT subinit a copy ofthis form othe Dey hie Abas investigation Repo Fore 11169 to sub to DON rountocndes7 a ‘On Monday April 23", Smastte relayed the following information to my self (Erik Jones), Jill Tabachnick, Dora Bromme, and Lisa Wood: “Mr. Johnson (a teacher and President of St, HOPE publics Schools} came up behind me and started to massage my shoulders. Soon his hands were on the top of my breasts, The situation grossed me out and that was not the first time. He has, on numerous occasions, hugged me and kissed me either on the cheek or on my forehead. He is a family friend, but I feel creeped out when he does this. He has also done this to other girls in the class and with one of the Hood Corps students he tried to crawl into her bed. And that is why she quit Hood Corps.”