Describe the incident(s). Please include when and where it happened. *
List the name(s) of the individual(s) accused of bullying and/or harassment.
Were there any witnesses? *
If yes, please list the names of the individual(s)
I certify that all statements on this form are accurate and true to the best of my knowledge. *
Today's Date *
Please deliver any supporting documentation to your building principal (i.e., copies of emails, notes, photos, etc.).Untitled Title
Note on confidentiality: In order to investigate the complaint, the district will disclose the content of the complaint only to those persons who have a need to know. This form will not be shown to the accused student(s)/staff.
Never submit passwords through Google Forms.
This form was created inside of potsdam.k12.ny.us. Report Abuse