Harassment, Intimidation, And Bullying Form - Greenwich-Stow Creek Township Partnership Schools

Greenwich-Stow Creek Township Partnership Schools

Harassment, Intimidation, and Bullying Form

FORM 1

(To Be Completed By The Individual Reporting The Incident)

Name and status of individual providing initial report:_____________________

(i.e., employee, volunteer, student, parent, community member, etc.)

Check box if you wish to remain anonymous:

Date of alleged incident:____________________

Name(s) of alleged victim(s):

Name(s) of alleged offender(s):

_______________________________

______________________________

_______________________________

______________________________

Description of the alleged incident(s). Include any gestures, any relevant

written/verbal/physical act(s) as well as any electronic communications and identity

what, if any, actual or perceived characteristics were or may have been a motivating

factor in the alleged incident. If necessary, please use a separate page and attach it to this

form:

0 votes

Parent category: Business