Reporting Form for Allegations of Bullying or Retaliation Related to Bullying
School:
*
Please Select
Arlington High School
Bishop Elementary
Brackett Elementary
Dallin Elementary
Gibbs School
Hardy Elementary
Menotomy Preschool
Ottoson Middle
Peirce Elementary
Stratton Elementary
Thompson Elementary
Other
Please choose the school that your child currently attends. If you are an APS employee, choose the school you currently work at.
Name of Person Filing the Report
*
If you do not wish to be identified, enter "Anonymous." Reports may be made anonymously unless reporter is a staff member or administrator. No disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous complaint.
Are you the target of the behavior or a reporter?
*
Target
Reporter
Both
Are you a student, staff member, parent or administrator?
*
Student
Parent
Staff Member
Administrator
Community Member
Staff members and Administrators, please specify your role.
*
Phone Number
Email
example@example.com
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Incident Information
Name of the Alleged Target (of behavior):
*
If unknown, type "unknown"
Name of the Alleged Aggressor:
*
If unknown, type "unknown"
Date of Incident. (click the green "+" button to add additional dates)
*
Location of Incident(s):
*
Please list names of people who saw the incident or have information about it:
*
Describe the details of the incident
*
Initial Determination Regarding Potential Civil Rights Violation:
If there is evidence indicating that the reported incident is related to a race, color, religion, national origin, age, sex, gender identity, sexual orientation, disability or other protected classification, the person receiving this report must arrange for the allegations to be processed under the district's harassment policy rather than bullying policy.
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