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DEI  |  Discrimination & Grievance Form


This Incident Report is NOT a 911 or Emergency Service. Do not use this site to report events presenting an immediate threat to life or property. If you require emergency assistance, please contact The Troy Police at (248)824-3477 or dial 911.

This form provides preliminary information to the Supervisor for Educational Equity, Inclusion, and Community Relations concerning incidents of protected status harassment, discrimination and related misconduct involving students, faculty, or staff. Please complete this form to the best of your knowledge.

Once you submit this form, you will be contacted for more information. Regardless of the nature of your report, the Troy School District will ensure that your report is forwarded to the office responsible for addressing it, as appropriate, based on the information you have provided. We cannot guarantee confidentiality, however, please know that this matter will be handled with discretion and information will be shared only with those who need to know.

Please note that reporting an incident without disclosing your name (i.e., anonymously) will prevent the Troy School District from being able to provide you with supportive measures (such as academic accommodations, no-contact orders, safe housing options, change of work schedule) because TSD staff will not be able to contact you. Reporting anonymously may also impact the District’s ability to investigate and/or take other actions.

If you have questions, please contact our office at cyancy@troy.k12.mi.us, or (248) 823-5056.
I am a...
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First Name
Last Name
Is this a recurring incident?
Location of incident
If a specific date is not known or occurred over multiple dates, please input the initial date of occurrence or when you first became aware and explain in more detail in the narrative description below.
(Must contain a date in M/D/YYYY format)
Details of complaint/grievance (Please check all that apply)Select all that apply if the nature of this report involves harassment, discrimination, hate/bias.
Select all that apply if the nature of this report involves harassment, discrimination, hate/bias.
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