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Anonymous Bullying Form


Security Measure

 

 

Randolph Public Schools

CIVIL RIGHTS & BULLYING

COMPLAINT REPORT

Students, parents and any member of the Randolph community can anonymously report bullying by completing a complaint form at the link, below. Reports will be automatically forwarded to the Randolph Public Schools District Safety & Security Administrator and to the appropriate principal for investigation.

Though reports may be made anonymously, the more information the administration receives in a report, the more helpful that report is. There is room on this reporting form for a reporter to include his or her name and contact information, and it is helpful to receive reports that include this information.

RPS will fully investigate all reports, anonymous or otherwise, and will notify parents of both the target and the aggressor, as required by law. However, no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report. 

Please select one:      

Name Of Reporter/Complaintant: 

Check whether you are the:      

Check whether you are a:  

Phone Number:   School: Grade:

 

Information about the Incident:

Name of Target: 

Name of Aggressor: 

Date(s) of Incident: 

Time of Incident(s): 

Location of Incident(s): 

 

Witnesses: ( People who saw the Incident or have relevant information )

Name:

Name:

Name:

Attach narrative, or DESCRIBE details of the incident below. INCLUDE names of persons involved, what occurred, who did what, including specific words and language used:

Signature of Reporter/Complainant:

Date:

Form provided to:

 

Received by:

Administrator's Signature: _________________________________

Date: ___________________