[City of Aurora] At Risk Mandatory Reporting

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Incident Tracking Number

You will be provided with a Incident Tracking Number upon submission.

Please select all that apply

I believe I am required by CRS 18-6.5-108 to make this report as a Mandatory Reporter of Mistreatment of At-Risk Elders (70 or older) or At-Risk Adults With I/DD (18 or older with I/DD diagnosis prior to age 22)

I am reporting this incident in order to comply with the Mandatory Reporting statute 18-6.5-108

I am reporting this incident because I believe the incident I am reporting is a criminal act that justifies the arrest and prosecution of the accused person to include potential incarceration of the accused

I believe the person who may be the subject of Mistreatment is:

70 years of age or older

18 years of age or older with a diagnosis of an Intellectual or Developmental Disability prior to the age of 22 (as defined in CRS 25.5-10-202(26)(a))

(Optional) This person is substantially disabled due and diagnosed with:

General Intellectual and/or Developmental Disability

Prader-Willi syndrome

Cerebral Palsy

Epilepsy

Autism

Neurological condition resulting in impairment of general intellectual functioning or adaptive behavior similar to I/DD]

Information regarding Mandatory Reporter

Age

Business Phone Number

Work Email

Is this a financial crime?

Yes

Business/agency/financial institution

What is the estimated amount of loss?

Will this be a write off loss?

The institution will return funds to the victim and write off the loss

This form will be required in order for APD to pursue the investigation of a financial crime against an At-Risk Elder or At-Risk Adult with I/DD.

Form cannot be completed online. Please print it out, complete it, and scan it, then upload it below

Financial Release Form

Upload Financial Release Authorization

I understand that no investigation will proceed until I have uploaded the completed form

Information regarding At-Risk Elder or At-Risk Adult with I/DD

Date of Birth or Age

Phone Number

Who is the primary care provider for reported victim At-Risk Elder or At-Risk Adult with I/DD?

The At-Risk person themself (no legal guardian, no power of attorney given to anyone else, able to complete ADLs)

Non-professional (family member, friend, etc.)

This person lives with the At-Risk person

Professional Care Provider

Date of Birth or Age

Phone Number

Agency/Business Name

Direct Phone Number

Direct Email Address

Information regarding the Accused Person (Enter the word "unknown" in any field that is not known about the suspect/offender)

Same as Primary Care Provider?

Yes

Date of Birth or Age

Suspect/Offender Phone Number

Suspect/Offender Email

Other Contact Information

Description of the reported mistreatment (Include date, time, location. Please be specific.)

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Incident Tracking Number

Please select all that apply

I believe the person who may be the subject of Mistreatment is:

(Optional) This person is substantially disabled due and diagnosed with:

Information regarding Mandatory Reporter

Full Name

Employment Address

Is this a financial crime?

Will this be a write off loss?

This form will be required in order for APD to pursue the investigation of a financial crime against an At-Risk Elder or At-Risk Adult with I/DD.

Upload Financial Release Authorization

Information regarding At-Risk Elder or At-Risk Adult with I/DD

Full Name

Residential Address

Who is the primary care provider for reported victim At-Risk Elder or At-Risk Adult with I/DD?

Full Name of care provider (if not the At-Risk person)

Residential Address

Agency/Business Address

Information regarding the Accused Person (Enter the word "unknown" in any field that is not known about the suspect/offender)

Same as Primary Care Provider?

Suspect/Offender Full Name

Suspect/Offender Address