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HS: DISCRIMINATION / HARASSMENT COMPLAINT FORM [DASA]
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* Indicates required question
Email
*
Your email
First Name
*
Your answer
Last Name
*
Your answer
Are you the person being bullied or harassed?
*
Yes
No
If you are not the person being bullied or harassed, please state who is.
Your answer
What time of day did this happen?
*
Your answer
Where did this happen?
*
Choose
Burton St. Elementary
Middle School
High School
School bus
Where, specifically, did this happen? ie. locker room, hallway, cafeteria
*
Your answer
Describe what happened the best way that you can.
*
Your answer
Send me a copy of my responses.
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