Mountain Valley Unified School District Harassment/Discrimination Incident Report Form
This is one of many formats you can use to report an incident. Please report in a format with which you are most comfortable and is you see something that is some form of harassment or discrimination, say something. the Title IX/ Civil Rights Officer receive the responses for this form. You are welcome to remain anonymous in reporting an incident. However, the more information you can provide, the better MVUSD may be able to respond to a situation.

MVUSD takes all reports seriously. Please do not abuse this reporting format.
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Today's date
School where you are a student or employee (or school where student for whom you are reporting goes):
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Name (optional)
Contact Information (optional)
How did you learn about the incident? The incident
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When did the incident occur?
Where did the incident occur?
Who was present when the incident occurred?
What other information can you share about the incident?
The person (or group of people) who is believed to have caused the incident were:
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Name(s) or descriptions of the person or people believed to have caused the incident.
People who may have knowledge of the relevant facts and a short summary of what they may know. Include contact information if available.
Please provide additional information you would like MVUSD to consider in addressing the report (i.e., confidentiality concerns, involvement with other individuals or agencies).
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