MTRSD Bullying, Harassment, Sexual Harassment, or Discrimination Report
Please use this form to report incidents of alleged bullying, harassment, sexual harassment, or discrimination.
I am reporting an incident of:
Your relationship to target:
Classmate or friend
Name of the target of bullying or harassment:
Name of the student(s) accused, if known:
The date and time such conduct took place:
Please describe the conduct or incident in as much detail as possible:
Where did this incident take place?
Were there any witnesses to the incident? If you know any names of those involved, please list them:
Did the target do any of the following things immediately after the incident?
Confronted the harasser(s) or person believed to be discriminating against them.
Stated the conduct that they object to.
Indicated that they finds such conduct offensive, intimidating and/or embarrassing.
Insisted that the person(s) engaging in the conduct stop the conduct immediately.
Reported the contact immediately.
If the incident was reported, to whom was it reported?
Any other details or information that might be helpful:
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This form was created inside of Mohawk Trail Regional School District.