(Student/Guardian) Racial Harassment, Bullying, Sexual Harassment, Discrimination and Bias Incident Report Form/ (Estudiante o guardián) Formulario de informe de incidentes de acoso racial, intimidación, acoso sexual, discriminación y prejuicios

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(Student/Guardian) Racial Harassment, Bullying, Sexual Harassment, Discrimination and Bias Incident Report Form/ (Estudiante o guardián) Formulario de informe de incidentes de acoso racial, intimidación, acoso sexual, discriminación y prejuicios

Students, parents/guardians and other concerned individuals may use this form to report bullying, harassment, sexual harassment or discrimination (including teen dating violence and sexual assault), bias incidents and general concerns.

Los estudiantes, padres o guardianes y otras personas preocupadas pueden utilizar este formulario para denunciar intimidación, acoso, discriminación, acoso sexual (incluida la violencia en el noviazgo y la agresión sexual entre adolescentes), incidentes de prejuicios y preocupaciones generales.

Email *

Today's Date/ Fecha de hoy *

YYYY

What type of incident are you reporting?

¿Qué tipo de incidente estás reportando?

BULLYING/HARASSMENT/ Intimidación o acoso: Intentional, repeated behavior that hurts, harms, intimidates or humiliates another person with words or actions. The hurtful behavior is carried out by those who have more power, such as students who are older, are physically bigger or stronger, have more social status, or form part of a group that singles out an individual. Bullying includes actions such as making threats, spreading rumors, attacking someone physically or verbally, and excluding someone from a group on purpose.

BIAS INCIDENT/Incidente de sesgo: Actions that are motivated in whole or in part by bias against a person's or group's race, color, religion, gender identity, sexual orientation, disability or national origin. It may be verbal, written, graphic or physical and includes slurs, displays of hate symbols (such as a noose or swastika), jokes, negative stereotyping and threatened or actual assault.

SEXUAL/GENDER-BASED HARASSMENT, ASSAULT & DISCRIMINATION/ Acoso, asalto o discriminación sexual: Unwelcome behavior that’s sexual in nature; bullying that’s based on someone’s real or perceived sexual orientation or gender identity; sexual assault; teen dating violence; and unfair treatment based on sex or pregnancy status.

RACIAL HARASSMENT/Acoso racial: Racially harassing conduct means unwelcome physical, verbal or nonverbal conduct based on the person’s actual or perceived race’ color’ national origin or ethnicity; or physical characteristics historically associated with race, a place of origin, protected class ethnicity or religious or cultural ancestry.

STUDENT BEING HARASSED BY STAFF/Acoso pereptuadopor un miembro del personal: When a student experiences bullying/harassment/threats from any 4J Employee

BULLYING SURROUNDING DISABILITIES/Intimidación por discapacidades

OTHER CONCERN/Otra preocupacón

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