DISPOSITION OF ANTI-BULLYING/HARASSMENT COMPLAINT FORM
Name of complainant:
Name of student or employee target::
Grade and building of student or employee:
Name and position or grade of alleged perpetrator /respondent:
Date of initial complaint:
Nature of discrimination or harassment alleged (Check all that apply)
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Age |
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Physical Attribute |
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Sex |
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Disability |
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Political Belief |
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Sexual Orientation |
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Familial Status |
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Race/Color |
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Socio-economic Background |
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Marital Status |
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Religion/Creed |
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Other – Please Specify: |
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National Origin/Ethnic Background/Ancestry |
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Summary of investigation:
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Signature:
Date: / /