SPS Complaint of Bullying Form
Suffolk Public Schools students, either individually or as a part of a group, shall not harass or bully others. Prohibited conduct includes, but is not limited to, physical intimidation, taunting, name-calling, and insults and any combination of prohibited activities. Prohibited  conduct  includes verbal conduct consisting of comments regarding the race, gender, religion, physical abilities or characteristics or associates of the targeted person. The principal and staff of Suffolk Public Schools are committed to addressing complaints of bullying and will respond promptly and appropriately to such complaints. Any student can complain about bullying by talking to an administrator and/or completing this form and returning it to an assistant principal or principal.

*This survey was adapted from Southeast Polk High School Bullying/Harassment Reporting Form.
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Email *
First Name of person reporting: *
Last Name of person reporting: *
School *
How can we contact you if needed? *
Phone number or email address...
Age of person reporting: *
First Name of victim: *
Last Name of victim: *
Age of Victim *
First Name of alleged bully: *
Last Name of alleged bully: *
Date of incident:
Give the approximate date and time the incident occurred.
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Time
:
Location of the incident: *
Required
Nature of Bullying or Harassment: *
Required
Type of Bullying or Harassment: *
Required
Description of the incident: *
Provide a detailed description of what happened and/or what was said.
Name of witnesses (if any):
Any other information:
Include reference to evidence you may have including text messages, posters, pictures...
How often has this issue occurred? *
Was this issue previously reported? *
Please enter the name of who this issue was previously reported to in the Other information field.
Required
I agree that all of the information is accurate and true to the best of my knowledge: *
NOTE: All complaints will be  followed  by an  investigation. Those  accused  as well as the parents of students involved will be informed of complaints, witnesses will be interviewed, and all  information will remain  confidential except for that which must be shared  as part of the investigation. By clicking yes below, you are verifying that your statements are true and exact to the best of your knowledge.
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