Where did the incident take place (check all that apply): *
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Type of incident (check all that apply): *
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Name any others who may have witnessed the incident: *
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Describe the incident. What happened? Be as specific as possible. What did the alleged offender say or do? Email any images to Mr. Carstens or Mrs. Schroeder: carstensf@tapestryschool.org, schroederv@tapestryschool.org. Add DASA to the subject line. *
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If there were any adults in the area when this happened, what did they do? *
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What the student (target) absent from school as a result of this incident? *
What was the type of bias (if know). Check all that apply.
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