Student Violence/Harassment/Intimidation/Bullying Complaint Form
This form complies with the Arizona Board of Education policy JICK-EA. Submission of this form verifies that all details are correct to the best of your knowledge.
Your Name *
Your Address *
Your phone number *
When is the best time to contact you on the number provided? *
Your email address *
I wish to file a complaint against: *
State the problem as you see it. Describe the incident, the participants, the background of the incident, and any attempts you have made to solve the problem. *
Be sure to include all relevant dates, times, and places.
If there is anyone who could provide more information regarding this complaint, please list names and phone numbers.
Indicate what you think can and should be done to solve the problem. Be as specific as possible. *
Submit
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