Statement of Assurance for Non-staff

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Regarding Ocean Township School Distict Policy 5512 HARASSMENT, INTIMIDATION, AND BULLYING

Email *

Full Name *

1. I have received the definition of Harassment, Intimidation and Bullying as set forth by Policy 5512 and by N.J.S.A. 18A:37-14.

2. I have received the online training modules provided by the State of New Jersey and the Ocean Township School District regarding the definition of Harassment, Intimidation and Bullying, reporting procedures and prevention efforts.

3. I understand that I am responsible to verbally report alleged Harassment, Intimidation and Bullying violations to the Principal or Principal’s designee on the same day as when I witnessed, or received reliable information, regarding any such incident. I further understand that I am required to submit a follow up report in writing to the Principal within two school days of the verbal report.

I have read and understand the above information. *

Yes

Required

I hold the following position(s): *

Classroom/School Volunteer (kid writing, media center, etc.)

PTO Room Parent

Student Teacher/ Intern

Substitute Teacher/ Aide

Board of Education Member

Other:

Required

I consent to signing this document electronically. *

Yes

Required

Electronic Signature *

This is considered your signature. Type your full name.

A copy of your responses will be emailed to the address you provided.

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