Harassment/Discrimination Report English Español I am a...* Student Parent Classified Employee Certified Employee Other Today's Date* Name* First Last Contact Email(Optional) Contact Phone Number*Date of Occurrence(s)* School/Location where the incident occurred*Type to search...003 - Cfa070 - Cte Career & Technical Education081 - Instr Media Center083 - Maintenance085 - Transportation086 - West Transportation Hub088 - District Operations089 - Purchasing/warehouse090 - Print Shop091 - Technology092 - Educational Services093 - Special Education094 - Human Resources095 - Student Services096 - Business Services097 - Data Services098 - Nutrition Services099 - District Office101 - Harbor Point Elementary School103 - Alpine Elementary School107 - Aspen Elementary School112 - Barratt Elementary School113 - Liberty Hills Elementary114 - Belmont Elementary115 - Black Ridge Elementary117 - Bonneville Elementary School121 - Cascade Elementary School123 - Cedar Ridge Elementary School125 - Cedar Valley Elementary School129 - Central Elementary School133 - Future Elem Site In Em (smith 11.47a)134 - Cherry Hill Elementary School138 - Deerfield Elementary School139 - Dry Creek Elementary140 - Eaglecrest Elementary School141 - Eagle Valley Elementary School144 - Foothill Elementary School145 - Forbes Elementary School147 - Fox Hollow Elementary148 - Freedom Elementary School152 - Silver Lake Elementary156 - Geneva Elementary School161 - Greenwood Elementary School166 - Grovecrest Elementary School170 - Harvest Elementary171 - Hidden Hollow Elementary172 - Highland Elementary School175 - Hillcrest Elementary School183 - Legacy Elementary School187 - Lehi Elementary School191 - Lindon Elementary School196 - Manila Elementary School200 - Meadow Elementary School201 - River Rock Elementary202 - Springside Elementary203 - Brookhaven Elementary204 - Mount Mahogany Elementary205 - Mountain Trails Elementary206 - Trailside Elementary School207 - North Point Elementary209 - Northridge Elementary School212 - Orchard Elementary School215 - Orem Elementary School216 - Parkside Elementary217 - Pony Express Elementary School218 - Ridgeline Elementary219 - Riverview Elementary220 - Rocky Mountain Elementary222 - Sage Hills Elementary223 - Saratoga Shores Elementary226 - Centennial Elmentary School232 - Sego Lily Elementary School237 - Sharon Elementary School242 - Shelley Elementary School247 - Snow Springs Elementary School253 - Suncrest Elementary School256 - Thunder Ridge Elementary258 - Traverse Mountain Elementary264 - Valley View Elementary School271 - Vineyard Elementary School275 - Westfield Elementary School277 - Westmore Elementary School286 - Windsor Elementary School299 - Alpine Online405 - American Fork Jr High School411 - Canyon View Junior High School417 - Frontier Middle School423 - Lakeridge Junior High School435 - Viewpoint Middle School441 - Lehi Junior High School450 - Lake Mountain Middle School459 - Orem Junior High School478 - Pleasant Grove Junior High485 - Oak Canyon Junior High School488 - Timberline Middle School490 - Vista Heights Middle School494 - Mountain Ridge Jr High School496 - Willowcreek Middle School704 - American Fork High School721 - Cedar Valley High School735 - Lehi High School737 - Lone Peak High School739 - Mountain View High School754 - Orem High School779 - Pleasant Grove High School782 - Polaris High School - East783 - Polaris High School - West785 - Skyridge High School786 - Timpanogos High School789 - Westlake High School790 - East Shore High School792 - Alpine Summit806 - Clear Creek Camp808 - Horizon School810 - Dan W. Peterson School815 - Atec944 - Asd Foundation989 - Covid Ppe WarehouseThe incident involved* Harassment Discrimination The incident was based on*(Click all that apply) Disability (Special Ed) Disability (504 Plan) Race Color National Origin Sex/Gender Religion Age Other Name of the person(s) you believe harassed or discriminated against you or another*FirstLast Add RemoveIf alleged incident was towards another person, identify that person(s)FirstLast Add RemoveDescribe the incident as clearly as possible, including such things as what force, if any, was used, any verbal statements (i.e. threats, requests, demands, etc.), what, if any, physical contact was involved.*When and where did the incident(s) occur?* List any witnesses who were presentFirstLast Add RemoveWhat would you like to see happen?Acknowledgement of Correct Information* I declare that the foregoing information is true and correct. I understand that neither I, nor anyone involved in the incident, are to retaliate against the other party. I also have the right not to be retaliated against by the other party involved in this incident. If I feel threatened in any way, or have concerns, I will contact the person in charge of this complaint. I hereby certify the information I have provided in this complaint is true, correct, and complete to the best of my knowledge. Signature* First Last Entering your name here indicates digital signatureDate Signed