Incident Report - Jewish LAUSD

ABOUT THIS FORM:
This submission form is designed to help JewishLAUSD advocate for better protections and more effective complaint procedures. Information is confidential and used only for legislative advocacy.

If you or your child have experienced an incident within LAUSD or issues with the Uniform Complaint Procedure (UCP), please share your experience below.

Note: This form is not affiliated with the ADL, CA vs Hate, LA vs Hate, or any other non-JewishLAUSD agency or organization.

JewishLAUSD Incident Report

Person Reporting

Please enter your full name, including your first and last name. This helps us keep track of your report and ensures we can follow up with you if needed.

Your Phone

Your Email Address

Affiliation(Required)

Please select your role from the options below to indicate your relationship to the incident being reported. This helps us understand the perspective from which the report is being made.

Student

Parent / Guardian / Family

Educator

Administrator

Concerned Individual

If you are under 13 years old, please do not submit this form. We ask that a parent or guardian complete the form on your behalf. We are committed to protecting the privacy of children and require parental consent before collecting any personal information from those under the age of 13.

We ask for the contact information of a parent or guardian to ensure that we can reach out to a responsible adult regarding the details of this report. This is important for your safety and to make sure that your concerns are properly addressed. Please rest assured that this information will be kept confidential and will only be used to follow up on this report as necessary.

Email(Required)

Educator

Are you a member of UTLA?(Required)

Yes

Are you a member of the Educator's Caucus for Israel?(Required)

Yes

Administrator

Are you a member of the Association of Jewish Educators?(Required)

Yes

School Information

Please provide details about the school involved in the incident. This information helps us identify where issues are occurring and allows for a more targeted approach in addressing them.

School Name(Required)

Start typing or select the name of the school where the incident took place. If your child's school is not listed, please choose 'Other' and specify the school in the additional comments section.

School Name - Other(Required)

Nature of Complaint(Required)

Please select all categories that apply to your complaint. This will help us categorize and understand the nature of the issues reported.

What Happened?(Required)

Please tell us what happened, including when and where it took place, who was involved, and anything else that might help us understand your experience. The more details you share, the better we can assist you.

Outcome or Follow-Up Actions (Optional)

Describe any follow-up actions taken by the school or district in response to your complaint, or if no action was taken. Please also indicate whether law enforcement, other government agencies, or organizations like ADL involved or informed. Providing this information helps us understand how the issue was handled after it was reported.

Response

Click here if you would like to be contacted about this incident.

Check this box if you would like us, or California legislative staff, to reach out to you regarding this report.

Best Time to Contact

Let us know when it’s most convenient for you to be contacted. We’ll do our best to reach out at a time that works for you.

By submitting this report, you affirm that the information provided is accurate to the best of you knowledge. You also consent to this information being shared with members of the California State Legislature for the purpose of supporting legislative efforts to improve the Uniform Complaint Procedure (UCP) within the State of California and the Los Angeles Unified School District (LAUSD). You understand that your submission is confidential and will be used solely for legislative advocacy purposes.

Please note that this information will not be sent to law enforcement, other government agencies, or other organizations; it is for legislative advocacy purposes only. If your complaint involves a serious health or safety emergency, or if you believe the matter should be reported to the appropriate authorities, please submit your complaint to law enforcement or the relevant agency immediately.