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DASA Incident Report
Your information, please list your first and last name and best way to contact you (phone/email). This information is optional.
As the person reporting the incident, please select the best choice below.
Select no more than 1.
The incident happened to me.
I witnessed the incident.
The incident was disclosed to me.
I overheard information regarding the incident.
I believe an incident could possibly occur.
Please enter the detailed information below regarding the student(s) involved.
Who is being targeted?
Grade Level of the student being targeted.
Who is accused of the offense?
Grade Level of the offender.
Please list the name(s) of any witnesses.
Date of the incident:
Time/Period that the incident took place.
Where did the incident happen? (Check all that apply)
Select at least 1.
On School Property
On School Bus
Off School Property
At a School Function
Other, please specify
Describe the Incident/Concern: