Brantley School's Student Harassment and Bullying Form
Please complete all sections of the form. A school level representative will receive this information and follow up with your concerns in a timely manner.
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Today's Date *
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School in which incident occurred *
Your Name *
Your relationship to the incident you are reporting *
Name of alleged student victim *
Age of alleged student victim *
Name(s) of alleged offender(s), if known. Please include grade level if known. *
On what date(s) did the incident happen? *
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Where did the incident happen? *
Required
Select all that apply *
Required
Describe the incident(s), including what the alleged offender(s) said or did. *
Why did the bullying, harassment, or intimidation occur? Choose all that apply *
Required
Did a physical injury result from this incident? Check the appropriate box *
Is there any additional information that you would like to provide? *
I agree that all of the information on this form is accurate and true to the best of my knowledge. *
Electronic Signature *
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