Student Handbooks JFK Student Handbook 2017-2018 | Page 40

ENFIELD PUBLIC SCHOOLS
FORM A
REPORT OF SUSPECTED BULLYING BEHAVIORS OR TEEN DATING VIOLENCE
( School Employees Should File with the School Principal ) ( Parents and Students May File with the School Principal or any other School Employee )
Name of Person Completing Report : ________________________________________________________ Date : __________________
Target ( s ) of Behaviors / Violence : ____________________________________________________________________________________________
Relationship of Reporter to Target ( self , parent , teacher , peer , etc .): _____________________________________________________________________________________________ _____________________________________________________________________________________________
Report Filed Against :
_________________________________________________________________________ Date of Incident ( s ): _________________________________________________________________________ Location ( s ):______________________________________
Time : _____________________________
Describe the basis for your report . Include information about the incident , participants , background to the incident , and any attempts you have made to resolve the problem . Please note relevant dates , times and places .
_____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________
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