See Policy 1.2.1 - Policy Against Sexual Harassment and Sexual Harassment Complaint Procedures

STUDENT HARASSMENT COMPLAINT FORM

 

NAME:________________________ DATE: ________________________
GRADE:_______________________

Who was responsible for the harassment?

Describe the harassment.

 

  

 

Date, time and place harassment occurred.

 

Were there others involved?

If so, who were they and describe involvement.

 

 

 

List any witness(s) to the harassment.

 

 

What was your reaction to the harassment?

 

 

 

Describe any subsequent incidents.

 

 

 

 

Signature:_________________________________________

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