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Thousand Islands CSD - Dignity Act
The Dignity for All Students Act amends Education Law to put in place procedures for creation of a school environment free of discrimination and harassment. "The legislature finds that students' ability to learn and to meet high academic standards and the school's ability to educate its students, are compromised by incidents of discrimination or harassment..."
The District condemns and prohibits all forms of discrimination and harassment of students based on race, color, weight, national origin, ethnic group, religion, religious practice, disability, sexual orientation, gender, or sex by school employees or students on school property and at school sponsored activities and events that take place off school property.
If you feel that a school employee or student has violated the protections assigned under the Dignity Act, please fill out the form below. All forms must contain all the information. Forms completed anonymously will be discarded. Contact information must be complete.
1. Name of individual making this report: *
2. In which building did this incident take place? *
Select at least 1.
3. Name of person(s) being harassed or discriminated against: *
4. Contact Phone Number (for parent or guardian if completed by student): *
5. Email address:
6. Under The Dignity Act, the individual(s) was harassed or discriminated against based on the following (check those that apply): If none apply check bullying and the incident, while not falling under the Dignity Act, will be addressed. *
Actual or perceived race or color
Religion, religious practice
Gender or sex
Bullying (it does not fall into any of the above categories under the Dignity Act)
7. Describe the incident, what did the alleged offender say or do: *
8. Date of incident: *
9. Where did the incident occur? *
Select at least 1 and no more than 1.
Playground / Recess
On the way to / from school
Electronic / Cyberbullying
10. Name(s) of individual harrassing/discriminating:
Name #1
11. Witnesses (if any):
Witness #1
12. Have you had issues with this student/employee previously?*
13. If you had a previous issue with this individual, what was it?
14. If you had a previous issue with this offender, was it reported through this syste m?
15. Is there any additional information you would like to provide?
16. Even though it will be completely up to the District to resolve this matter, I feel the best course of action would be: *
Educate the offender.
Have a counselor meet with the offender.
Have the offender meet with the counselor and the target to appologize and resolve the issue.
Send to the principal for discipline.
17. What grade level range is the target (the alleged victim of discrimination/harassment) in: *
By pressing "Submit" I am affirming under penalty of perjury, I understand that in a written instrument, any person who knowingly makes a false statement which such person does not believe to be true has committed a crime under section 210.45 of NYS Penal Law.