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High School DASA Report/Complaint Form
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Más información
* Indica que la pregunta es obligatoria
Part I. Basic Information
Incident occurred (check one)
*
During regular schools hours
Before or after regular school hours
Obligatorio
Location of incident (check one)
*
Auditorium
Boys bathroom
Bus
Cafeteria
Girls bathroom
Girls locker room
Gymnasium
Hallway
Parking Lot
Playground
Playing field
Pool
Cyber Offense
Otro:
Obligatorio
Incident occurred (check one)
*
On school property
At school sponsored function off school grounds
Off school property (select this only if it is a cyber offense)
Obligatorio
Incident was (check all that apply)
*
Gang related
Bias related
Otro:
Obligatorio
Part II. DASA
Description of Incident: (please use as much detail as possible, such as who was involved, how it happened and if there were any injuries)
*
Tu respuesta
Bias(es) of Incident (check all that apply)
*
Actual or perceived race
Gender
Sex
Color
National orgin
Sexual orientation
Disability
Religion
Weight
Ethnic group
Religious practices
Otro:
Obligatorio
Person Reporting (First and Last Name)
*
Tu respuesta
Email
Tu respuesta
Phone Number
Tu respuesta
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