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Click here to view our policy on bullying/hazing

Bully, Intimidation, Harassment and Hazing Reporting Form

This form is confidentially maintained in accordance with the Family Educational Rights and Privacy Act, 20 U.S.C 1232g. Bully, Harassment & Intimidation as defined by Arizona State Statute (A.R.S.) §15-341(40) Hazing as defined by Arizona State Statute (A.R.S.) §15-2301

Knowingly submitting a false report will result in disciplinary action.

Directions: Bullying, intimidation, harassment and/or hazing are not acceptable. Please complete this form to report alleged bullying, intimidation, harassment and/or hazing and return it to the school administration office. Please contact the school for additional information or assistance at any time. Please be informed that any anonymous, unsigned form may make it impossible to prove any allegations.

All fields marked with an asterisk (*) are required.

Please Select a School:(*)
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Today's Date:(*)

Name(s) of Person(s) Reporting Incident:(*)
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Telephone Number:(*)

Email:(*)

Are you (check one):(*)

Name(s) of Student Victim(s):(*)
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Name(s) of Alleged Offender(s):(*)

Name(s) of Witness(es):(*)

On what date(s) did the incident(s) occur?(*)

If you experienced more than one occurrence, please enter additional dates in the fields below
On what date(s) did the incident(s) occur?
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On what date(s) did the incident(s) occur?
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Was a report filed with the School Administration?(*)
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If not, why?
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Where did the incident(s) occur?(*)
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Other (Please Explain):
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What best describes what happened?(*)

Other ( Please Explain):
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Explain what you saw and/or heard:(*)

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