LGBT
Discrimination Report |
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| Name of School: | |
| Your name:..................................................................................Date: | |
| • Please describe the incident: | |
| • Where & when did it happen? | |
| • Who was involved? (include everyone) | |
| 1 | 4 |
| 2 | 5 |
| 3 | 6 |
| • Where there any witnesses? ........................What are their names? | |
| First Name: .............................Last Name:....................................Phone: | |
| 1 | |
| 2 | |
| 3 | |
• Was there any faculty or staff around? ...........Who were they and how did they respond? |
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