STUDENT HARASSMENT AND BULLYING COMPLAINT FORM
The Alabama State Department of Education requires each school system to establish a procedure for the investigation of all incidents reported to school officials of harassment, violence, threats of violence, or intimidation by any other student. This form will assist schools in the Baldwin County Public School System in investigating these reported incidents of such behavior.
What is your name? *
Your answer
Name of alleged student victim (who is being bullied) *
Your answer
Name(s) of alleged offender(s), if known. (Who is bullying someone) *
Your answer
Name of alleged witness(es), if known: (who saw it) *
Your answer
When did the incident happen? What date, and what time of day? *
Your answer
Where did the incident happen? *
Place a check next to the statement(s) that best describe(s) what happened. (Choose all that apply.) *
Required
Describe the incident(s), including what the alleged offender(s) said or did. *
Your answer
Why did the bullying, harassment, or intimidation occur? *
Your answer
Did a physical injury result from this incident? (Check the appropriate box.) *
Is there any additional information that you would like to provide? (Please print.) *
Your answer
I agree that all of the information on this form is accurate and true to the best of my knowledge *
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