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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.
Full Name *
Location of Incident *
Date and Time of Incident
Describe the Incident *
List the name(s) of the individuals accused of intimidation, harassment, and/or discrimination:
Were there any witnesses?
If yes, list the name(s) of the individual(s):
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