Bullying Form

School *

Name(s) and Grade(s) of Victim(s) *

Name and Title of Person Reporting *

Relationship to Victim

Name(s) of Accused *

Location of Incident

Date of Incident

Time of Incident HHMM

Describe what happened and who was present. If there were other incidents, please list here. *

I certify that all information provided in the complaint is true and complete. I understand that any intentional misstatement of fact may subject me to school discipline. *

I agree

Verification