Burton ISD School Violence/Bullying Complaint Form
Please fill out the following form to the best of your knowledge, with as many details as needed to help an administrator follow-up with more expediency on the most recent incident.
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Current Date *
MM
/
DD
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YYYY
Current Time *
Time
:
Grade of Injured Party *
Date of Incident *
MM
/
DD
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YYYY
Approx. Time of Incident *
Time
:
Location of Incident *
List the Name of Alleged Perpetrator(s) *
Relationship Between You and Alleged Perpetrator(s) *
Describe the Incident(s) *
Were there any witnesses? *
If there were any witnesses, then please list them?
Is this the first incident? *
If no, how many times has it happened before?
Other Information (including previous incidents or threats)
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