CHUSD Bullying Complaint Form (ENG)
It is the intent of the Coalinga Huron Unified School District to provide a process for students, parents, and members of the community to address complaints of bullying to appropriate district personnel and to receive a prompt response to this complaint without fear of retaliation.

It is also the intent of the Coalinga-Huron Unified School District to protect students or personnel from unfair and unfounded accusations, to conduct a prompt and reasonable investigation, and to resolve any complaints in accordance with school and district policies and procedures. To the extent possible, individuals investigating this incident will protect the confidentiality of the parties reporting the incident.

Submission of this report form is encouraged; however oral reports shall be considered official reports.

Reports may be made anonymously, but formal disciplinary action may not be based solely on an anonymous report. Any student who feels she/he is a victim of bullying should immediately contact a teacher, counselor, principal, administrator or staff person. Staff shall assist students and/or parents in completing the bullying complaint form, as requested.
Student Name
Your answer
Date of Report
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Date of incident
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Person(s) involved with the complaint
Your answer
Location of the incident(s)
Your answer
Did you report this incident of Bullying?
If yes, to whom?
Your answer
When and where did you report it?
Your answer
Please describe the incident in as much detail as possible.
Your answer
What was the basis of the discrimination, harassment
Name of Person Filing Complaint (can be submitted anonymously)
Your answer
Date
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YYYY
Contact Number
Your answer
Address
Your answer
Email address
Your answer
Check One
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