Student to Student: Complaint Form - Discrimination, Anti-Bullying, & Anti-Harassment (Board Policy 104)

The Newton Community School District is committed to providing all students, employees and volunteers with a safe and civil school environment in which all members of the school community are treated with dignity and respect. Bullying and/or harassment behavior can seriously disrupt the ability of school employees to maintain a safe and civil environment, and the ability of students to learn and succeed.

Complaints may be filed with the superintendent or superintendent’s designee pursuant to the regulation accompanying this policy. The superintendent is responsible for implementation of this policy and all accompanying procedures. Complaints will be investigated within a reasonable time frame. Within 24 hours of receiving a report that a student may have been the victim of conduct that constitutes bullying and/or harassment, the district will notify the parent or guardian of the student. 

Please find Policy 104: Anti-Bullying/Anti-Harassment here.

Please find Regulation 104-R(1): Anti-Bullying/Anti-Harassment, Investigation Procedures here.

Email *
Last Name *
First Name *
Are you filling this form out for yourself or someone else? *Please identify the individual if you are submitting on the behalf of someone else *
Phone Number *
Date of Complaint *
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Have you spoken to a NCSD staff member regarding this incident? *
If yes, please list who
Who or what entity do you believe discriminated against, or bullied you (or someone else)? *
Date of alleged incident(s): *
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Location of alleged incident(s): *
Name of any witnesses, if any: *
Nature of discrimination, harassment, or bullying alleged (Check all that apply) *
Required
If you selected 'Other' above, please specify:
In the space below, please describe what happened & why you believe that you or someone else has been discriminated against, harassed, or bullied. Please be as specific as possible. *
I agree that all of the information on this form is accurate & true to the best of my knowledge. *
A copy of your responses will be emailed to .
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