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Incident intake form
The Muslim Parent Association is committed to finding the resources to support our students and families. In order for us to better advocate for our families and to pull resources, we are asking you to share your experiences. We want to be able to track any incidents of harm or harassment, verbal or non-verbal, your family has witnessed and/or experienced. We encourage folks to fill out this intake form to document any incidents of harassment/hate. We also welcome any feedback regarding actions you’ve taken to report/address these concerns.
Name & Email
What grades are your child(ren) in?
What District(s) are your child(ren) in?
Los Angeles Unified
Santa Monica Unified
Culver City Unified
Santa Clarita/Valencia Unified
Providing as much detail as possible, please offer a report of the incident that occurred, including date/time, names of persons involved, location, specifics regarding what was said/done.
Based on the above, do you feel safe?
Did you report the incident?
If you answered 'yes' above, to whom did you report the incident? (If not applicable, please indicate N/A).
If you reported the incident above, have they responded?
Is there anything else you would like to share or feel we should know?
Thanks for submitting!
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