District Bullying Incident Report
If you have been the target of bullying or have witnessed bullying of a Grain Valley School District student, complete this form and submit to the district representative. Complaints against building principals should be submitted to the Superintendent. Complaints against the Superintendent should be submitted to the Board of education. Reports of bullying will be investigated and disciplinary action will be taken as warranted.

Students have the right to complete and submit this form anonymously. However, it will be be easier to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of bullying or harassment will not affect the complainant or reporter's future employment, grades, learning, or working environment. A complainant who falsely accuses someone will be subject to disciplinary action.
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Date *
School Where Incident Occured *
Name
Contact Phone Number
Check the Box of the Person Reporting The Bullying *
Required
Name of person(s) who is being subject to bullying. *
Date(s) of bullying incident. *
Person(s) alleged of committing the bullying or harassment. *
Summarize the incidents or occurrences of bullying as accurately as possible. *
Submit
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