Council 1A Form
*Use this form to report a concern about school culture.
*Each report will be investigated with due process
* Required
Email address
*
Your email
Your Name
Your answer
Grade of Person Making the Report
Your answer
Date of the Most Recent Incident
MM
/
DD
/
YYYY
What is your concern?
Verbal Slur
Hate Speech
Physical Threat
Intimidation
Inappropriate Attention
Other:
Please provide a detailed description of the event. In order for us to help we need as many details as possible.
Your answer
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