DASA Incident Report
  Lowville Central School District is committed to providing a safe, supportive environment free from harassment, bullying and discrimination for all students. The District 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, cyber-bullying, and/or discrimination, please use this form to report all incidents. Students witnessing an incident or a victim of an incident should report the incident as soon as possible.  All complaints will be treated in a confidential manner. Anonymous reports may limit the district’s ability to respond to the complaint. A prompt and thorough investigation will be conducted for all incident reports.  
Email *
Name *
Date *
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Grade *
Date of Incident being reported *
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Approximate Time of Incident *
Time
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Location of Incident

Be as specific as possible.Whose classroom? Which hallway? Which gym? Etc. 
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Description of Incident

Please be sure to include all the details you remember about the incident you are describing. Who was involved? Where was it at? When did it happen? What happened? Was this an isolated event or has it happened before?
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Other students that were involved

If you know first and last names include both. 
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Witnesses (if any) to the event. 

If you know first and last names include both. 
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