Bullying Incident Report Form

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If you have been the target of bullying or have witnessed the bullying of a district student, complete this form and submit to the building principal. Complaints against building principals should be submitted to the superintendent. Complaints against the superintendent should be submitted to the Board of Education. Reports of bullying will be investigated and disciplinary action will be taken as warranted.

Please Note

Students have the right to complete this form anonymously. However, it will be easier for the district to investigate this matter if as much information as possible is provided. Submissions of a good faith complaint or report of bullying or harassment will not affect the complainant or reporter’s future employment, grades, learning, or working environment. A complainant that falsely accuses someone will be subject to disciplinary action.

Building you attend *

Today's Date *

YYYY

First and Last Name

Phone Number *

Please enter your phone number in the following format: XXX-XXX-XXXX

Indicate the appropriate response(s) to the following: *

You are a:

Student

Parent

Employee

Volunteer

Other:

Required

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