Incident Reporting Form – Sturgis Charter Public School

This form can be completed anonymously. However, providing your contact information will enable the school to conduct a more thorough investigation and resolution. Staff members cannot make an anonymous report of an allegation or suspicion of bullying or civil rights discrimination of a student.

Bias Incident Reporting Form

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Your Name

First Last

Your Email Address

Email Address Confirm Email Address

Your Phone

School(Required)

Affiliation(Required)

Communication Preference(Required)

Were you the target or a bystander/witness?(Required)

Date of Incident

Time

Location of Incident(Required)

Do you feel this was a bias incident?(Required)

Nature of the bias incident(Required)

Description of Incident with any further details(Required)

All involved parties(Required)

List all parties, i.e. witnesses, aggressors, and targets (list people who saw or heard the incident, persons who engaged in the behavior, or may have information about it; or say unknown)

Would you like to upload a file or image related to the incident?

Drop files here or

Accepted file types: jpg, gif, png, pdf, Max. file size: 500 MB.

Bias Incident Reporting Form

Next Steps: Sync an Email Add-On

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