Fairview School Bullying Reporting Form
By submitting this Complaint Form, you certify that all statements made in the complaint are true and complete. Any intentional misstatement of fact will subject you to appropriate disciplinary action. I authorize school officials to disclose the information I provide only as necessary in pursuing the investigation.
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Name of person completing this form (OPTIONAL) You can report anonymously.
List the name of student(s) accused of bullying: *
Relationship between you and the accused student: *
List the name of student(s) who is the victim of the bullying: *
Date(s) of incident: *
Place of incident (bus, playground, class, online, etc.) *
Type of Bulling: *
Required
Please share as many details as you can about the bullying incident(s): *
Were there any other witnesses? *
Has this been previously reported? If so, to whom was it reported?
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