Discrimination And Harassment Report Form

Discrimination and Harassment Report Form

Use this form to report violations of the Green Bay Area Public School District Pupil Non-Discrimination Policy 411 or Policy 411.11 and Wis. Stat. § 118.13.

Fields marked with a red asterisk (*) must be filled in.


Student/Person Filing Report *    
Relationship to Student (if necessary) 
Phone Number *    
Email (optional)   
School *    
Date(s) of Alleged Incident(s) *    
Protected Class *    




National Origin/Ancestry/Creed


Marital/Parental Status

Sexual Orientation

Gender Identity

Gender Expression

Gender Non-conformity





Individual(s) Involved    
Incident Description *    
Action Requested by Person Filing *    


*Nothing in these procedures shall preclude persons from filing a complaint directly or on appeal with the U.S. Office of Civil Rights – Region V in Chicago, Illinois for federal law discrimination complaints or with a court of law.

**The District is requesting that the complainant access school policy first.

Wis. Stat. § 118.13. Pupil Discrimination Prohibited

(1) Except as provided in s. 120.13(37m), no person may be denied admission to any public school or be denied participation in, be denied the benefits of, or be discriminated against in any curricular, extracurricular, pupil services, recreational, or other program or activity because of the person’s sex, race, religion, national origin, ancestry, creed, pregnancy, marital or parental status, sexual orientation or physical, mental, emotional, or learning disability.

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