Harassment and Violence Reporting Form
Bloomington Public Schools maintains a firm policy prohibiting all forms of harassment and violence. Everyone is to be treated with respect and dignity. Harassment or violence by any student, teacher, administrator or other school personnel which creates an intimidating environment will not be tolerated under any circumstances.

The District will respect the privacy of the complaint, the individual(s) against whom the complaint is filed and the witness as much as possible, consistent with the District's legal obligations to investigate, to take appropriate action, and to conform with any discovery or disclosure obligations.
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Your name and phone number (optional but helpful). Please understand, without providing your contact information it may be difficult to pursue this report.
I am a: *
Describe what happened: Include information on the harasser/offender, victim and any witnesses/bystanders. The more detail you provide, the better. *
Please indicate the basis of alleged harassment/violence. Check all that apply. *
Required
Please indicate the Bloomington school/program site in which the offender, victim, and/or witnesses/bystanders are connected to (ex: what school does the student attend?). Check all that apply. *
Required
Date the incident occurred. *
MM
/
DD
/
YYYY
Where did the incident occur (ex: bus, classroom, hallway, playground) *
Have you talked with anyone else about this incident? If so, who? (optional)
Addition information (optional). Example: time of day incident occurred, etc.
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