Complaint Form – Student Bullying, Harassment, Intimidation

Contact Info

Complaint Form

I wish to submit a complaint against
Specify your complaint by stating the problem as you see it. Describe the incident, the participants, background to the incident, and any attempts you have made to solve the problem. Please include all relevant dates, times, and places. Additional pages may be attached if necessary.
If there is anyone who could provide more information regarding this complaint, please list name(s), address(es), and telephone number(s).

Projected Solution

Indicate what you think can and should be done to solve the problem. Be as specific as possible.


I certify this information is correct to the best of my knowledge (sign by typing your initials).