Report an Incident

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Report an Incident

All reports will be received by the Weld Re-5J District Compliance Officer. You will be contacted within 24 hours.

Weld County School District Re-5J
Brandi Trevino -Title IX Coordinator/Compliance Officer
110 South Centennial Dr., Ste. A,
Milliken, CO 80543

(970)617-4025

Do you want to be contacted? *

Yes

I would like to remain anonymous (please add the names of the victims and/or witnesses)

If you wish to be contacted please include your name and contact information.

Date/Fecha *

YYYY

What type of interaction occurred? *

A student towards another student

A staff member towards a student

A staff member towards another staff member

A student towards a staff member

Other:

Type of incident (Please check all that apply)/Tipo de incidente (Marque todo lo que corresponda) *

Immigration or Citizenship Status/inmigración o ciudadanía

Disability/Discapacidad

Sexual Orientation/orientación sexual

Gender Expression/Expresión de género

Gender Identity/Identidad de género

Language/idioma

Religion/Religión

Race/Raices

National Origin/Origen nacional

Other:

Required

Location (address) /lugar (direccion) *

Describe the incident (include names and witnesses)/Describa el incidente (incluya nombres y testigos) *

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