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Click ‘Get Form’ to open the DASA Consumer Complaint Form in the editor.
Begin by entering the date at the top of the form. This helps establish a timeline for your complaint.
Fill in your name as the complainant, followed by your address and phone number. Ensure all contact information is accurate for follow-up.
Indicate whether you wish to remain anonymous by selecting 'Yes' or 'No'. Remember that some information may still be disclosed under Public Disclosure law.
Decide if you want to be contacted regarding the outcome of your complaint and mark your choice accordingly.
Specify your relationship to the subject of the complaint, such as patient, parent, or employee.
Identify whether your complaint concerns a non-certified agency or a DASA-certified agency. Provide their name, address, and phone number.
If applicable, check any agency personnel involved in the complaint and provide their names and titles.
In the complaint description section, detail what happened, who was involved, when and where it occurred, and any actions taken in response. Use additional pages if necessary.
Once completed, forward this form to the DASA Certification Section using the provided contact details.
Start filling out your DASA Consumer Complaint Form online for free today!
A DASA complaint form must be posted on the District website and communicated to parents and students on an annual basis. To be completed by person reporting the incident (or the person receiving the complaint and/or investigating the incident) and submitted to the Dignity Act Coordinator (DAC).
What is the purpose of a DASA report?
DASA explicitly mandates the reporting of all incidents of harassment, bullying, and/or discrimination based on, but not limited to, a persons race, color, weight, nationality, ethnicity, religion, disability, sexual orientation, gender (which includes gender identity and/or expression), or sex.
Why was Dasa created?
THE PURPOSE OF THE DIGNITY ACT New York States Dignity for All Students Act was established with the broad legislative intent to provide a school environment free of discrimination and harassment.
What is the purpose of the DASA?
New York States Dignity for All Students Act (The Dignity Act) seeks to provide the States public elementary and secondary school students with a safe and supportive environment free from discrimination, intimidation, taunting, harassment, and bullying on school property, a school bus and/or at a school function.
What happens when a DASA report is filed against you?
Under DASA, when a complaint is lodged, an investigation must be undertaken promptly. This investigation should be conducted by a DASA coordinator, or another person designated by the DASA coordinator if the DASA coordinator is unavailable.
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Incident Reporting Form. (For District/School Files Only). I. To be completed by person reporting the incident (or the person receiving the complaint and/or
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