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...All SchoolsAlpine Elementary SchoolAlpine OnlineAlpine SummitAmerican Fork High SchoolAmerican Fork Jr High SchoolAsd FoundationAspen Elementary SchoolAtecBarratt Elementary SchoolBelmont ElementaryBlack Ridge ElementaryBonneville Elementary SchoolBrookhaven ElementaryBusiness ServicesCanyon View Junior High SchoolCascade Elementary SchoolCedar Ridge Elementary SchoolCedar Valley Elementary SchoolCedar Valley High SchoolCentennial Elmentary SchoolCentral Elementary SchoolCherry Hill Elementary SchoolClear Creek CampCovid Ppe WarehouseDan W. Peterson SchoolData ServicesDeerfield Elementary SchoolDistrict OfficeDistrict OperationsDry Creek ElementaryEagle Valley Elementary SchoolEaglecrest Elementary SchoolEast Shore High SchoolEducational ServicesFoothill Elementary SchoolForbes Elementary SchoolFox Hollow ElementaryFreedom Elementary SchoolFrontier Middle SchoolGeneva Elementary SchoolGreenwood Elementary SchoolGrovecrest Elementary SchoolHarbor Point Elementary SchoolHarvest ElementaryHidden Hollow ElementaryHighland Elementary SchoolHillcrest Elementary SchoolHorizon SchoolHuman ResourcesInstr Media CenterLake Mountain Middle SchoolLakeridge Junior High SchoolLegacy Elementary SchoolLehi Elementary SchoolLehi High SchoolLehi Junior High SchoolLiberty Hills ElementaryLindon Elementary SchoolLone Peak High SchoolMaintenanceManila Elementary SchoolMeadow Elementary SchoolMount Mahogany ElementaryMountain Ridge Jr High SchoolMountain Trails ElementaryMountain View High SchoolNorth Point ElementaryNorthridge Elementary SchoolNutrition ServicesOak Canyon Junior High SchoolOrchard Elementary SchoolOrem Elementary SchoolOrem High SchoolOrem Junior High SchoolParkside ElementaryPleasant Grove High SchoolPleasant Grove Junior HighPolaris High School - EastPolaris High School - WestPony Express Elementary SchoolPrint ShopPurchasing/warehouseRidgeline ElementaryRiver Rock ElementaryRiverview ElementaryRocky Mountain ElementarySage Hills ElementarySaratoga Shores ElementarySego Lily Elementary SchoolSharon Elementary SchoolShelley Elementary SchoolSilver Lake ElementarySkyridge High SchoolSnow Springs Elementary SchoolSpecial EducationSpecial Education DepartmentSpringside ElementaryStudent ServicesSuncrest Elementary SchoolTechnologyThunder Ridge ElementaryTimberline Middle SchoolTimpanogos High SchoolTrailside Elementary SchoolTransportationTraverse Mountain ElementaryValley View Elementary SchoolViewpoint Middle SchoolVineyard Elementary SchoolVista Heights Middle SchoolWest Transportation HubWestfield Elementary SchoolWestlake High SchoolWestmore Elementary SchoolWillowcreek Middle SchoolWindsor Elementary SchoolThe 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