Student Accident Report 504.10E

In this section, please fill out all of the student's demographic information.

Injury Information

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Accident Information

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Nondiscrimination Statement
The Sioux City Community School District is an equal opportunity/affirmative action employer. It is an unfair or discriminatory practice for any educational institution to discriminate on the basis of race, creed, color, sex, sexual orientation, gender identity, national origin, religion, age (for employment), disability, socioeconomic status (for programs), marital status (for programs), or veteran status in its educational programs and its employment practices.  Inquiries or grievances may be directed to Jen Gomez, Director of Student Services & Equity Education at 627 4th Street, Sioux City, IA 51101, (712) 279-6075, gomezj2@live.siouxcityschools.com.