DASA/Bullying Complaint Form
22 Questions
To be completed by the person reporting the incident (or the person receiving the complaint and /or investigating the incident). Please fill out this form with as much information as possible.
(student being bullied, harassed, or discriminated against)
(student being bullied, harassed, or discriminated against)
Please indicate if the offender (#1) was a student, faculty, or staff member.
Please indicate if the offender (#2) was a student, faculty, or staff member.
Please indicate if the offender (#3) was a student, faculty, or staff member.
(check all that apply)
(check all that apply)
(check all that apply)
Describe what was said and/or done and by whom.
Please identify any other people who may have witnessed the incident(s). Please indicate if they were a student or adult.
If yes, please identify who you reported the situation to and on what date.
Forms
4 forms were found.