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DASA Reporting Form

Required

Please fill out this electronic form to report any incidents or concerns regarding bullying or harassment. This form can be automatically submitted to the Whitesboro Central School District by clicking on the "Submit" button at the bottom of the page. Questions with an asterisk must be answered to submit the form. The accused student or staff member will not be shown this report. Due to privacy laws, you likely will not be notified of the outcome of the school district's investigation.
Name
First Name
Last Name
Must contain a date in M/D/YYYY format
Must contain a date in M/D/YYYY format
Time of Incident(s)requiredPlease select up to 4 choices
Please select up to 4 choices
Place of Incident(s)requiredPlease select up to 10 choices
Please select up to 10 choices
Do you know the name of the person being bullied?required
What school does the person being bullied attend?required