Confidential Incident Reporting Form
Prior to completing this form, CVUSD does encourage you consider reporting any incidents of harassment, intimidation, bullying or discrimination to the school site principal. However, we recognize that for some students and families, that may not feel safe or have attempted and the outcome felt incomplete or insufficient. Therefore, we created this central reporting option because CVUSD takes seriously any incidents of bullying, discrimination, harassment, intimidation and racism. Please complete this form to report an incident that occurred that you were either directly involved in or you directly observed. When conducting an investigation of this report we will keep your name confidential to the extent possible. If you wish to submit a form anonymously please leave Name and Email sections blank. Please note email is not required but necessary in order to make contact with you.
In order for CVUSD to follow-up, are you in agreement to have a Student Support Services staff member call or email you for additional information? If yes, please provide your contact information above.
Acacia Magnet School
Colina Middle School
Conejo Valley High School
Conejo Valley Independent Study
EARTHS Magnet School
Ladera STARS Academy
Lang Ranch Elementary
Los Cerritos Middle School
Newbury Park High School
Open Classroom Leadership Magnet
Redwood Middle School
Sequoia Middle School
Sycamore Canyon (TK-5)
Sycamore Canyon (6-8)
Thousand Oaks High School
Westlake High School
Westlake Hills Elementary
I am a
Other family member
What was the nature of the incident? Select all that you believe apply
Did you initially make a report of this incident to an adult at the school site?
If yes, please provide the name of the individual, although not required.
Do you feel the response was sufficient?
Were you on the receiving end of this incident?
Did you witness the incident occurring with another person?
Please provide the first and last name(s) of any other individuals involved in this incident if you know the name(s).
Please provide any other information you feel is important.
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This form was created inside of Conejo Valley Unified School District.