NCCIP
Missing/Abducted Child On-Line Notification Form

Reporter Information

*Full Name: 
*Mailing Address:
*City:    County:    *State:    Zip Code:
*Daytime Phone:    *Evening Phone:   
Social Security #:--    Date of Birth:
*Relation to Child:  Custodial Parent Noncustodial Parent Legal Guardian Law enforcement Grand parent Family Relative Other
E-Mail Address: 

Incident Information

*Date child became missing/abducted:   Type of Incident: Family Abduction Nonfamily Abduction Runaway Stranger Abduction Unknown Missing   
*The child became missing (city & state) from:
*Provide a brief explanation of the incident:

Provide any information on the possible destination of child:
No information known
*Was the incident reported to law enforcement?  Yes     No   Date Reported:
*Law enforcement agency name:   
*City:    *State:    *Phone Number:    
Law Enforcement Agency Case #:    NCIC #:
Investigating Officer:

Missing/Abducted Child # 1 Information

*First Name:    Middle Name:     *Last Name:    Nickname:
*Date of Birth:    Social Security Number:    Height:  Sex: Sex Male Female
Weight:    *Race: Caucasian African American Native American Asian Hispanic Other   *Eye Color: Blue Green Hazel Brown   *Hair Color: Black Brown Blonde Other Red  
Hair Style:
*Provide description of clothing that child was last known to be wearing:
unknown
Check all that apply:
Glasses:    Contacts:     Braces:    Right-handed:    Left-handed: Scars/Marks:    
Describe any scars and/or marks that the child may have and its location on body, if applicable (i.e., surgical scars, injury scars, birthmarks, etc.):

Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

Describe any medical or mental condition that the child may have:

• If there are additional children that are missing/abducted, continue filling out the form providing the additional information

• If there are no other children to report, click the submit button

Missing/Abducted Child #2 Information

First Name:    Middle Name:     Last Name:    Nickname:
Date of Birth:    Social Security Number:    Height:  Sex: Sex Male Female
Weight:    Race: Caucasian African American Native American Asian Hispanic Other   Eye Color: Blue Green Hazel Brown   Hair Color: Black Brown Blonde Other Red  
Hair Style:
Provide description of clothing that child was last known to be wearing:
unknown
Check all that apply:
Glasses:    Contacts:     Braces:    Right-handed:    Left-handed: Scars/Marks:
Describe any scars, marks or tattoos that the child may have and its location on body, if applicable:

Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

Describe any medical or mental condition that the child may have:

• If there are additional children that are missing/abducted, continue filling out the form providing the additional information

• If there are no other children to report, click the submit button

Missing/Abducted Child #3 Information

First Name:    Middle Name:     Last Name:    Nickname:
Date of Birth:    Social Security Number:    Height:  Sex: Sex Male Female
Weight:    Race: Caucasian African American Native American Asian Hispanic Other   Eye Color: Blue Green Hazel Brown   Hair Color: Black Brown Blonde Red Other  
Hair Style:
Provide description of clothing that child was last known to be wearing:
unknown
Check all that apply:
Glasses:    Contacts:     Braces:    Right-handed:    Left-handed: Scars/Marks: 
Describe any scars, marks or tattoos that the child may have and its location on body, if applicable:

Tattoos:
Describe any tattoos that the child may have and its location on body, if applicable:

Describe any medical or mental condition that the child may have:

If you wish to return to the top of the form and review/edit the information you have entered, click here.