Anti-Racism, Anti-Discrimination and Anti-Harassment Reporting Form

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Online Reporting Form

Complainant / Reporter Name *

You are welcome to select who you would like to submit this form to for initial review. You will receive a notification of submission. You may submit this form anonymously. However, if you choose to submit anonymously, you will not be able to receive a follow up contact from the SKSD.

To submit anonymously type anonymous in the box below.

Address *

Phone *

Email *

School Building and Grade / Location *

Name(s) of Policy Violators *

Name(s) of Alleged Victim(s) – if different from the Complainant / Reporter *

Contact information of Alleged Policy Violator(s) where available: *

Please provide specific details of the alleged incident(s). Make sure to include the date(s), time(s), and place(s) where the alleged incident(s) occurred. *

Did anyone witness the event? *

Yes

If yes, please provide the name(s) and contact information, if known, of any witnesses. *

Have you had a prior experience with this individual or have you reported this same individual previously for Policy Violation(s)? *

Yes

If yes, please provide as much information as possible about the prior report, including the date. *

Additional Comments: *

Complainant / Reporters Signature *

I hereby certify to the best of my knowledge, that all of the above-mentioned information is true, accurate and complete.

Who would you like to submit this form to? *

SKSD Human Resource

SKSD Superintendent

Required

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