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Dignity for All Students (DASA) Incident Report Form
The purpose of this form is to inform the district of an event or series of incidents of intimidation, harassment, and/or discrimination so that we can investigate and take appropriate action. If you are a student who feels unsafe, or the parent of a child that feels that way, fill out this form and speak directly with your Dignity for All Students Act Coordinator (Mr. Woughter) as soon as possible so we can address you concerns.
*Require Fields
Email address *
Full Name *
Your answer
Location of Incident *
Your answer
Grade *
Your answer
Date and Time of Incident
Your answer
Describe the Incident *
Your answer
List the name(s) of the individuals accused of intimidation, harassment, and/or discrimination:
Your answer
Were there any witnesses?
If yes, list the name(s) of the individual(s):
Your answer
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