DASA Reporting Form*
Dignity For All Students Act Reporting Form

No student shall be subjected to harassment by employees or students on school property or at a school function; nor shall any student be subjected to discrimination based on a person's actual or perceived race, color, weight, national origin, ethnic group, religion, religious practice, disability, sexual orientation, gender (including gender identity or expression), or sex by school employees or students on school property or at a school function.

Please click Continue to fill out a reporting form to describe any instances of harassment (including bullying) or discrimination that you have witnessed or experienced on school property or at a school function. This may also include cyber bullying on any social media web site which may impact an individual's educational experience or attendance. PLEASE NOTE - Questions with an asterisk are required to complete this form.

Please provide the name of the person filling out this report.* *
Your answer
Please provide either a phone number or valid email address so we may contact you for further information if needed. * *
Your answer
Are you the person being harassed (bullied) or discriminated against? * *
If you are NOT the person being harassed (bullied) or discriminated against, have you witnessed someone else being harassed (bullied) or discriminated against? * *
Which school does the person who was harassed (bullying) or discriminated against attend.* *
Required
If you witnessed or are the victim of an incident of harassment (bullying)or discrimination, please provide the name of the target of harassment (bullying) or discrimination. If you DO NOT know the name of the target please enter the word - Unknown * * *
Your answer
Where is (/has) the harassment (bullying) or discrimination occurring? * *
Required
Please describe with as may details as possible the event of harassment (bullying) or discrimination in the area below. * *
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Oneida City School District. Report Abuse - Terms of Service - Additional Terms