Bullying Incident Report Form

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If you (or your child) 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 Board of Education. Reports of bullying will be investigated and disciplinary action will be taken as warranted.

Email *

Date Filed *

YYYY

Your Full Name *

Contact Phone Number *

You are a *

Student

Parent

Employee

Volunteer

Date(s) of alleged bullying:
*

YYYY

Summarize the incident(s) or occurrence(s) of bullying as accurately as possible.
*

Names of witnesses
*

Have you reported this to anyone else?
*

Yes

Submit

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