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Dignity Act Complaint
Your name
*
First Name
Last Name
Your relationship to the district
*
Employee
Student
Parent/Guardian
Employment Applicant
Other
Home address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Which school is this complaint associated with?
*
High School
Middle School
North Street
West Street
How would you characterize the discrimination, harassment, or other concerning conduct? (Check all that apply.)
*
Age
Disability
Ethnic group/National origin
Gender/Sex
Race/Color
Religion/Religious practice
Retaliation for making or participating in a complaint
Sexual harassment, sexual offense, or stalking
Sexual orientation
Weight
Other
Name(s) and, if known, title(s) of person(s) whose conduct you are reporting
*
Where did the incident occur?
*
For example: at school, on a school bus, at an off-campus event, online/social media, etc.
Date the incident occurred
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Explain what happened
*
Names of any witnesses or others who may have information about the incident(s)
Names of anyone with whom you have discussed the incident(s)
Has this been previously reported?
*
Yes
No
Submit
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