Harassment and/or Bullying Complaint Form - Harding Avenue Elementary School

*Please note, required fields are in red.

Today's Date:

Name of person reporting incident:

Student Name:

Grade:

Date of incident:

Please provide details of incident:

List the names of the individuals accused of bullying and/or harassment:

Were there witnesses? If so, please list names:

If you're not a student, please enter your contact information. Include where you can be reached (Mobile phone and email address):

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