Panama Central School District DASA Reporting Form
Panama Central School District is committed to providing a safe, supportive environment free from harassment, bullying or discrimination. As a District, we encourage the involvement of staff, students, parents and community members in the implementation and reinforcement of the Dignity for All Students Act (DASA). 

If you believe that a student has been the target of harassment, bullying (including cyberbullying), or discrimination, please use this form to report the allegations. School or district personnel who witness an incident or receive a report of an incident must immediately notify the principal, superintendent or designee, and must complete and submit this written report within two (2) days.

All complaints will be treated in a confidential manner. Anonymous reports may limit the district's ability to respond to the complaint. A prompt and thorough investigation will be conducted for all incident reports. 


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What is the name of the student who was the target of bullying, harassment, or discrimination? *
What is the grade level of this student? *
Where did this incident happen? *
When did the incident happen? (date/time)
Please provide the name(s) of the person(s) accused of bullying, harassment, or discrimination, if known.
Describe the incident as completely as possible.
Provide the name(s) of any witnesses who may have observed the incident.
What is your relationship to the student(s)? *
If you are willing to provide your name, please do so. This report will be kept confidential. *
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