GMS Peer Conflict Report
Email address *
Student Making Complaint *
Your answer
Name of Person(s) you believe harassed you: *
Your answer
List any witnesses that were present: *
Your answer
Where did the incident occur? (Be specific. "In school" doesn't help. Say the teacher's classroom, or the specific spot in the hallway, etc.) *
Your answer
When did the incident occur? (Be specific) *
MM
/
DD
/
YYYY
Time
:
Describe the incident as detailed as possible. *
Exact statements of what was said, any physical contact, anything that lead to the incident, etc.
Your answer
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