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Dignity for All Students (DASA)

Dignity for All Students Complaint/Harassment & Discrimination Reporting Form 7550F
Fairbanks Road Elementary School

Required

Complainant Namerequired
First Name
Last Name
Must contain a date in M/D/YYYY format
Type of bias (actual/perceived) based on the complainant - check all that apply Please select up to 12 choices
Please select up to 12 choices
Place a check next to the statement(s) that best describe(s) the incident- check all that applyPlease select up to 4 choices
Please select up to 4 choices
Location of incidentrequiredPlease select up to 1 choice
Please select up to 1 choice
Your Namerequired
First Name
Last Name

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