MSD: Bullying Complaint Form
This form is to document alleged bullying, harassment, or intimidation that occurred on school property, at a school-sponsored activity or event off school property, on a school bus, or on the way to and/or from school.
If you are a student victim, the parent/guardian of a student victim, or a close adult relative of a student victim, or a school staff member and wish to report an incident of alleged bullying, harassment, or intimidation, complete and submit this online form. The form will be reported to the Principal of the School, but feel free to contact the school for additional information or assistance at any time.
Please be aware that intentionally making a false report or retaliation against any person who reports, is thought to have reported, files a complaint, or otherwise participates in an investigation or inquiry concerning allegations of bullying is prohibited may result in disciplinary action.
Date of the incident:
School at which the incident happened:
Garfield Elementary School
Marinette High School
Marinette Middle School
Merryman Elementary School
Park Elementary School
Sunrise Early Learning Center
Person reporting the incident:
Please select the appropriate box, are you:
Close adult relative
Name of alleged victim:
Name of alleged offender(s) if known:
Where did the incident happen (please choose all that apply):
On a school bus
On the way to/from school
Cyberbullying that affects the school setting
On school property
Please identify the statement(s) that best describes what happened (choose all that apply):
Getting another person to hit or harm the student
Teasing, name-calling, making critical remarks, stalking, taunting, coercing, menacing, or threatening in person or by other means
Demeaning and making the person the victim of jokes
Making rude and/or threatening or inappropriate gestures
Excluding or rejecting the student
Intimidating (bullying), extorting or exploiting
Spreading harmful rumors or gossip
Electronic communication (such as cyberbulling)
Please state any additional concerns, descriptions, or details below (i.e., what did the alleged offender(s) say or do? How did it make you feel?)
What is the nature of this incident?
Pregnancy, Marital or Parental Status
To impress others
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This form was created inside of Marinette School District.