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TUSD BIAS REPORTING
This form is for students to report bias incidents that take place during the school year.
If you are physically threatened or there is an immediate safety concern, please contact your school's administration.
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* Indicates required question
Email
*
Your email
Please select your school site
*
Choose
Brown Elementary School
Crowell Elementary School
Cunningham Elementary School
Dutcher Middle School
Earl Elementary School
eCademy Charter at Crane School
Julien Elementary School
Medeiros Elementary School
Osborn Two-Way Immersion Academy
Pitman High School
Roselawn High School
Turlock Junior High School
Turlock High School
Wakefield Elementary School
Walnut Elementary School
Do you want to remain anonymous?
*
Yes. By checking yes, I understand that I will not receive any follow up, but my report will be documented.
No
Last Name (If anonymous, enter NA)
Your answer
First Name (If anonymous, enter NA)
Your answer
I am a current TUSD:
*
Student
Anonymous Student
Faculty
Anonymous Faculty
Parent
Anonymous Parent
Other
If other selected in previous section, please describe your relationship to student.
Your answer
Please indicate the type of BIAS incident you would like to report.
*
Race/Ethnicity
Gender Identity
Sexual Orientation
Disability
Religion/Spirituality
Other
If other selected describe the BIAS identity or identities targeted.
Your answer
Where did the BIAS incident take place?
*
Classroom on campus
On campus - non classroom
Online/Social Media
Off Campus
Online/Other
Other:
When did the BIAS incident occur? For each incident, include date(s) the BIAS occurred.
*
Your answer
What is the name of each person(s) involved in the BIAS incident?
*
Your answer
Please describe the BIAS incident(s).
*
Your answer
Please provide the names of any person(s) who was present and witnessed the BIAS incident(s).
Your answer
Have you attempted to discuss your complaint with any Turlock Unified School District Personnel? If so, with whom and what was the result?
*
Your answer
What would you like the program/school to do as a result of your report-what remedy or resolution are you seeking?
Your answer
Certification: By checking the box below, I certify that the information I have submitted is accurate and truthful.
I certify the information is true and accurate.
Submit
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