104.E(2) - Witness Disclosure Form

Name of Witness: ___________________________________________________________________________________

Date of interview: ___________________________________________________________________________________

Date of initial complaint: _____________________________________________________________________________

Name of Complainant ______________________________________________________________________________

(include whether the

Complainant is a student _______________________________________________________________________

or employee):

Date and place of alleged ________________________________________________________________________

incident(s):

________________________________________________________________________

Description of incident(s) witnessed:

__________________________________________________________________________________________________

Additional information: ______________________________________________________________________________

__________________________________________________________________________________________________

I agree that all of the information on this form is accurate and true to the best of my knowledge.

Signature: _____________________________________ Date: __________________________

I.C. Iowa Code                                    Description
Iowa Code § 216.9                                Unfair/Discriminatory Practices
Iowa Code § 280.28                              Harassment and Bullying Prohibited
Iowa Code § 280.3                                Education Program - Attendance Center Requirements
Iowa Code § 279.82                              Intra-District Enrollment

I.A.C. Iowa Administrative Code Description
281 I.A.C. 12.3 Administration

U.S.C. - United States Code                   Description
20 U.S.C. §§ 1221                                  Education - FERPA - General Provisions
29 U.S.C. §§ 794                                   Labor - Vocation Rehab Rights
42 U.S.C. §§ 12101                                Public Health - Equal Opportunity - Disabilities
42 U.S.C. §§ 2000d                                Public Health - Civil Rights - Federally Programs

U.S. Supreme Court Description
551 U.S. 393 Morse v. Frederick (2007)

Case Law Description
Morse v. Frederick 551 U.S. 393 (2007)

Cross References: 102 Equal Educational Opportunity
102-R(1) Equal Education Opportunity - Grievance Procedure
102-E(1) Equal Education Opportunity - Annual Notice of Nondiscrimination
102-E(2) Equal Education Opportunity - Continuous Notice of Nondiscrimination
102-E(3) Equal Education Opportunity - Notice of Section 504 Student and Parental Rights
102-E(4) Equal Education Opportunity - Discrimination Complaint Form
102-E(5) Equal Education Opportunity - Witness Disclosure Form
102-E(6) Equal Education Opportunity - Disposition of Complaint Form
401.01 Equal Employment Opportunity
402.03 Abuse of Students by School District Employees
404 Employee Conduct and Appearance
404-R(1) Employee Conduct and Appearance - Code of Professional Conduct and Ethics Regulation
404-R(2) Employee Conduct and Appearance - Code of Rights and Responsibilities Regulation
604.11 Appropriate Use of Online Learning Platforms
605.06 Internet - Appropriate Use
605.06-R(1) Internet - Appropriate Use - Regulation
605.06-E(1) Internet - Appropriate Use - Internet Access Permission Letter to Parents
605.06-E(2) Internet - Appropriate Use - Violation Notice
605.08 Artificial Intelligence in the Educational Environment
605.08-R(1) Artificial Intelligence in the Educational Environment - Regulation
713 Responsible Technology Use & Social Networking
713-R(1) Responsible Technology Use & Social Networking - Regulation

Approved: 9/17/2025, 9/18/2023, 11/18/2024, 9/15/2025
Reviewed: 8/15/2025
Revised: 8/15/2025

dawn.gibson.cm… Wed, 06/24/2026 - 20:39