Bully Complaint Form
I attend *
Name of person making the complaint. *
Your answer
Date and time of complaint. *
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Time
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Address *
Your answer
Email Address *
Your answer
Phone number
Your answer
Relationship with person allegedly being bullied. *
Your answer
Name of person you are making a complaint against. *
Your answer
Specify your complaint by stating the problem as you see it. Describe the incident, the participants, the background to the incident, and any attempts you have made to solve the problem. Be sure to include all relevant dates, times, and places. Be as specific as possible. *
Your answer
If there is anyone who could provide more information regarding this complaint, please list name(s), address(es), and telephone number(s). *
If none, please state "none".
Your answer
Please indicate what you think can and should be done to solve the problem. Please be as specific as possible. *
Your answer
By adding my initials in the box below, I understand that what I have written in this complaint is factual to the best of my knowledge. I am also aware that knowingly submitting false reports shall subject students to disciplinary action. *
Please type your initials in the box below to represent your electronic signature.
Your answer
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