RSCS Harassment Complaint Form
Dignity for All Students Act  (DASA) Reporting Form:  RSCS encourages 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 you, or someone else, has been the target of harassment, bullying--including cyberbullying--or discrimination, please use this form to report all allegations.  This form will automatically be directed to the school administrator.
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Reporting Person:
Note: Anonymous reports may limit the district’s ability to respond to the complaint.
Grade level of student(s): *
Date and time of incident: *
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Time
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Name of victim(s): *
Alleged perpetrator(s): *
Witnesses, if any (name or identifying information) *
Type of harassment (click all that apply): *
Required
Harassment was based on actual or perceived (click all that apply): *
Required
Where did the harassment take place? *
People the victim has spoken to about the harassment incident: *
Description of the incident: *
Other relevant information: *
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