Editing previous response:

Please fix the highlighted areas below before submitting.

REPORT FORM FOR HAZING AND BULLYING (Policy: JFCF-E)

Please complete the form below. Required fields marked with an asterisk *

Click the links below to review our Hazing and Bullying policies.

Hazing and Bullying (Harassment, Intimidation and Dating Violence (Policy JFCF)

Hazing and Bullying Response Procedure (Policy JFCF-R)

Complainant:*

Answer Required

School

Answer Required

Home Address, Work Address, Home Phone, Work Phone:*

Answer Required

Who is the target of the alleged harassment, intimidation, and/or bullying:

Answer Required

Name of person(s) involved in the alleged hazing or bullying behavior:*

Answer Required

Date of alleged incident(s):*

Answer Required

Number of times that the alleged conduct has occurred:*

Answer Required

Location(s) where the alleged conduct has occurred:

Answer Required

Describe the alleged incident as clearly as possible, including such things as what force, if any, was used; any verbal statements (i.e. threats, requests, demands, etc.); what if any physical contact was involved. *

Answer Required

Attach additional pages as necessary

Answer Required

Choose a file or drag it here.

List any witnesses who were present:*

Answer Required

This complaint is based upon my honest belief that the person(s) listed above has hazed or bullied me or another person. I hereby certify that the information I have provided in this complaint is true, correct and complete to the best of my knowledge.

Complainant (Your typewritten name will serve as your signature):

Answer Required

Date:

Answer Required

Received by:

Answer Required

Date:

Answer Required

Fairfield City School District, Fairfield, Ohio

Confirmation Email

Email Required