Bullying/Conflict Report 2023-2024

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Please fill out the form completely and accurately as possible. The completed form will be automatically sent to Mr. Ballagh, Mrs. Miller, and Mr. Grimes once you submit and a timely investigation into the complaint will take place.

Name of Person (First & Last) completing the report

Are you reporting a conflict situation or a bullying situation? *

Conflict - 2 or more people having a disagreement, argument, or a difference of opinions/interests.

Bullying - Bullying is when someone repeatedly and on purpose says or does mean or hurtful things to another person. The person has already asked the student to stop and no change of behavior has occurred.

Date of Complaint *

Name of person(s) involved in the conflict or alleged harassment/bullying situation *

Date and place of incident(s) *

Nature of Discrimination or Harassment: *

Age

Disability

Gender Identity

National Origin/Ethnic Background

Physical Attribute

Physical/Mental Ability

Race/Color

Religion

Sex

Sexual Orientation

Socioeconomic Background

Other

Required

Description of Misconduct *

Name of witnesses (if any) *

Evidence of Bullying/Harassment/Conflict *

Ex: photos, letters, etc.

Any other information? *

I agree that all of the above information is accurate and true to the best of my knowledge. *

Yes

Required

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