Dignity Act/Incident Form
The purpose of this form is to inform the District of an incident or series of incidents, so that the District can investigate and take appropriate action.
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Email address *
1. Your Name (Please type your first and last name) *
2. Person filling out this form *
3. Today's Date
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4. Phone Number
5. Date of alleged incident
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6. Were there any witnesses? *
7. If yes, list the name(s) of the witness(es).
8. Where did the incident(s) take place? (i.e. hallway near pool, social media, bus, etc.) *
9. Describe the incident. (Please use as many details as possible) *
10. What supporting documentation (i.e., copies of emails, notes, photos, etc.) do you have related to this incident? Please list these items below and save a copy for the Main Office.
11. Has the incident been previously reported? *
12. If yes, when and to whom did you report this incident?
13. Do you believe that this incident was bullying, harassment, or discrimination? *
14. I certify that all of the information that I provided on this form is true and accurate. *
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