Documente Academic
Documente Profesional
Documente Cultură
SCHOOL DISTRICT
September 2012
TABLE OF CONTENTS
Bullying, Sexual harassment, Dating Violence and Sexual Violence .....................3
Your Right to File a Complaint ......................................................................................3
Instructions....................................................................................................................3
Bullying Incident Report Form .......................................................................................4
Bullying Incident Follow-up Form ..................................................................................5
Sexual Harassment, Dating Violence & Sexual Violence Report Form .........................6
Notice of Parent and Student Rights .............................................................................8
School-Based Stay-Away Agreement .........................................................................11
Student-On-Student Altercation Response Chart........................................................14
Child Abuse ...............................................................................................................16
Child Abuse Reporting Information & Law from the Texas Family Code.....................17
Recognizing Child Abuse ............................................................................................19
The Child .......................................................................................................19
The Parent......................................................................................................19
The Parent and Child .....................................................................................19
Types of Abuse ...........................................................................................................20
Signs of Physical Abuse..............................................................................................20
Signs of Neglect ..........................................................................................................20
Signs of Sexual Abuse ................................................................................................21
Signs of Emotional Maltreatment ................................................................................21
Resources on the Child Welfare Information...............................................................22
Appendix....................................................................................................................23
_____________
Repeat Incident?
YES
Time of Incident:
_____________
NO
Restroom
On Bus
Other:
Classroom
Parking Lot
Gym
To/From School
Lunchroom
Afterschool
Playground
School Event
Locker Room
Text/Phone
Name(s) of Witnesses/Bystanders
Type of Bullying:
Verbal
Result in Injury?
YES
NO
Physical
YES
NO
Relational
Reported to Police?
YES
NO
Bullying Behaviors:
Shoved/Pushed
Threatened
Stole/Damaged Items
Excluded
Taunting/Ridiculing
Writing/Graffiti
Staring/Leering
Intimidation/Extortion
Demeaning Comments
Inappropriate Touching
Text Messages
Social Media
Racial
Sexual
Religious
Disability
Other
Student
Bystander
Target/Target
Parent
Bus Driver
Anonymous
Other
Email/Text
Graffiti
Video/Audio
Social Media
Other
Time: _________
Result: ________________________________________________________________
Signature: _________________________________________________
Follow-up Conference
Date:_________________________
Time:____________________________
__________________________________________________
Counselor
__________________________________________________
Social Worker
__________________________________________________
Teacher
__________________________________________________
Student
__________________________________________________
Parent
__________________________________________________
Witness (s)
__________________________________________________
Other
__________________________________________________
________ Better
_________ Worse
_________ No Difference
Comments:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
Parent Contact:
Additional Action/Notes:
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
____________________________________________________________________________________________
[ ] yes
[ ] no
I certify that all statements made in the complaint are true and complete. Any
intentional misstatement of fact will subject me to appropriate discipline. I
authorize school officials to disclose the information I provide only as necessary
in pursuing the investigation.
Signatures
Student: _____________________________________________ Date: ___________
School official receiving complaint: ________________________ Date: ___________
School official conducting follow-up: _______________________ Date: ___________
Notes of action taken:
______________________________________________________________________
______________________________________________________________________
Signature of Student/Staff
Date
Documentation/Follow-Up
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
definition includes behavior including but not limited to incest, molestation, child abuse, stranger
rape, and non stranger rape.
A student or employee, who believes they have been harassed, bullied, or otherwise targeted
by fellow students or LISD employees are encouraged to promptly report such incidents to the
campus principal or other campus professional. To the greatest extent possible, complaints
shall be treated as confidential. Limited disclosure may be necessary to complete a thorough
investigation.
A student or parent/guardian who has a complaint alleging bullying, harassment, dating
violence, or sexual violence may request a conference with the principal or the principals
designee. If the student or parent/guardian is not satisfied with the response form the campus
staff, they may request a conference with the Superintendent or designee, or LISDs Title IX
Coordinator.
Complaints will be documented and investigated in accordance with LISD policy and guidelines.
Any staff member who observes an incident that involves physical or sexual assault or threats
will report the incident immediately to the principal. Any staff member who learns of an incident
or threat may submit a Complaint Form on behalf of the target.
Campus Complaint Procedure:
1. Students and staff members will complete a Complain Form available from the campus
administration or counseling office.
2. The Complaint Form will be submitted to the principal or designee immediately.
3. The principal or designee will investigate complaints by meeting separately with each
student involved in the situation.
4. The campus administration or counselors will conference with the targeted student and
parent/guardian to discuss safety and community resources.
5. The administrator will have a conference with the alleged perpetrator and
parent/guardian to discuss appropriate behaviors and consequences. With the prior
consent of the targeted student, the administration may issue a School-Based StayAway Agreement to the alleged perpetrator during the parent/guardian conference.
6. Documentation of Complain Forms, Follow-Up Actions, and Stay-Away Agreements will
be available to the General Counsel at all times.
Please review this information and return this signed page to the school, retaining the prior two
pages for your records.
For more information about your rights and responsibilities concerning bullying, harassment,
dating violence or sexual violence, please contact LISDs Title IX Coordinator.
___________________________
________________________________
____________________
Parent/Guardian Name
Parent/Guardian Signature
Date
________________________
Student Name
____________________________
Student Signature
__________________
Date
________________________
Administrator Name
____________________________
Administrator Signature
__________________
Date
10
______________________________________________
______________________________________________
______________________________________________
Date of assessment: ____________________________________________________
Date of parent/guardian notification: ________________________________________
In order to protect the rights and safety of all members of our school community,
you are required to stay away from (name of target)
_____________________________________________________________________
at all times during the school day and at any school-sponsored event. This means
that you may not approach, talk to, sit by, or have any contact with (name of target)
_____________________________________________________________________
at school or on school property, school buses, and bus stops.
11
Current Schedule
New Schedule __________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Lunch: ________________________________________________________________
Locker: _______________________________________________________________
Extracurricular Activities: _________________________________________________
Other disciplinary actions:
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Violations of this agreement and acts of retaliation directly or indirectly toward
the target or the targets friends or family members will be taken seriously and
will result in further disciplinary actions. Your compliance will be monitored by
(name and staff title):
______________________________________________
Agreement is valid from ________________________to _______________________
date
date
This agreement will be reviewed on ________________________________________
date
Signatures
Student: __________________________________________ Date:________________
Parent/Guardian: ___________________________________ Date: ________________
Administrator: ___________________________________ __ Date: ________________
12
ACTIONS
1.
2.
3.
4.
5.
13
6.
7.
14
as CPS requirements.
[
8.
9.
10.
11.
[
]
There are no findings of inappropriate behavior.
After determination made:
Give notice of the outcome to the parties follow FERPA
guidelines.
Advise the parents and students that they may appeal the
decision of the principal or designee regarding the outcome of
the investigation into the allegation. Inform the student or
parent/guardian that he or she may request a conference with
the Superintendent or designee and that a written complaint
must be submitted. The appeal notice must be filed in writing,
on a form provided by the District. Refer to Board Policy FFH
(LOCAL) and FNG (LOCAL).
If findings indicate that inappropriate behavior has occurred:
Monitor the safety of the targeted student.
Encourage the target to immediately communicate any safety
concerns that may arise to an administrator or counselor or
School Resource Officer.
Document subsequent follow-up actions and complaints in the
space provided on the complaint form.
Advise Title IX Coordinator by email or memo of all incidents of sexual
harassment that occur on your campus. Label correspondence regarding sexual
harassment issues Attorney-Client Privileged Information. Include (a) the date
of the incident, (b) the names of the students involved in the incident, (c) actions
taken to address the matter, and (d) whether the matter is closed or remains
open. Use form titled Reports of Allegations of Sexual Harassment (Title IX).
Store complaint forms in a separate, confidential file.
15
CHILD ABUSE
16
17
18
CHILD ABUSE
The first step in helping abused or neglected children is learning to recognize the signs
of child abuse and neglect. The presence of a single sign does not prove child abuse is
occurring in a family, but a closer look at the situation may be warranted when these
signs appear repeatedly or in combination.
If you do suspect a child is being harmed, reporting your suspicions may protect the
child and get help for the family. Any concerned person can report suspicions of child
abuse and neglect.
Recognizing Child Abuse
The following signs may signal the presence of child abuse or neglect.
The Child:
The Parent:
19
Types of Abuse
The following are some signs often associated with particular types of child abuse and
neglect: physical abuse, neglect, sexual abuse, and emotional abuse. It is important to
note, however, that these types of abuse are more typically found in combination than
alone. A physically abused child, for example, is often emotionally abused as well, and
asexually abused child also may be neglected.
Consider the possibility of physical abuse when the parent or other adult caregiver:
Signs of Neglect
Consider the possibility of neglect when the child:
Consider the possibility of neglect when the parent or other adult caregiver:
20
Consider the possibility of sexual abuse when the parent or other adult caregiver:
Is unduly protective of the child or severely limits the childs contact with other
children, especially of the opposite sex
Is secretive and isolated
Is jealous or controlling with family members
Consider the possibility of emotional maltreatment when the parent or other adult
caregiver:
21
22
APPENDIX
23
INDICATORS
OF CHILD ABUSE
PHYSICAL ABUSE
SEXUAL ABUSE
PHYSICAL INDICATORS
Surface Area Injuries
Non-accidental Bruising Patterns
Loop or Wrap Around Injuries
Injuries in Various Stages of Healing
Complications from Old Injuries
Imprint of Instrument on Skin
Cigarette Burns
Shows Signs of Overall Poor Health
PHYSICAL INDICATORS
Headaches, Stomach Ache, and
Overall Not Feeling Well
Pain in Anal or Genital Area
Recurring Vaginal or Bladder Infections
Sexually Transmitted Disease
Oral, Genital or Anal Bleeding
Redness, Swelling, Itching or Trauma
to the Genital/Anal Area
Pregnancy
BEHAVIORAL INDICATORS
Unable to Explain Injury or Explanation
Inconsistent with Injury
Unusually Fearful, Non-spontaneous
Overly Eager to Please Adults
Discomfort About Undressing in Front
of Peers
BEHAVIORAL INDICATORS
Sudden Change in Behavior
Fears/Phobias, Retreat to Fantasy
Disturbed Sleeping Patterns
Changes in Relationships to Adults
(Avoidance or Clinging)
Problems in School
Withdrawal from Friends/Family
Running Away
Inappropriate and Obsessive Sexual
Awareness, Promiscuity
Compulsive Masturbation
Depression, Low Self-esteem, Self
Critical
Child States an Adult is Bothering Him
or Her
Verbalization of Sexual Assault
Discomfort About Undressing in Front
of Peers
Discomfort or Extreme Sensitivity to
Physical Contact
Friends who are Several Years Older
Acquisition of Unexplainable Toys,
Money or Clothes
Regression to More Childish Behavior
Delinquent Acts
Suicidal Gestures or Attempts
Plays Parental Role
24
*NOTE: Please remember that all of the signs/symptoms above could be related to other
problems and/or emotional issues that the child is encountering. So, it is important to not
assume that just because a child is exhibiting the behaviors above that they have definitely
been sexually abused. It is believed that it is always best for someone to show concern for the
child by taking the time to ask the child if there is something wrong, or is they can help in some
way; remembering to take a calm, accepting approach when talking with the child. Many
children will not tell until they are asked. And, even if they choose not to tell when they are first
asked, they will know that there is someone that cares and that they can talk to when they are
ready.
PROMISCUITY
25
26
My 8 Rules for
* Safety. *
1.
2.
3.
4.
5.
6.
7.
It is never too late to ask for help. I can keep asking until
I get the help I need.
8.
27