Newton County School District Bullying/Harassing Complaint Form

1. Name of person reporting: ____________________________________________________________
2. Specific nature of the misconduct: __________________________________________________________

_____________________________________________________________________

_____________________________________________________________________
_____________________________________________________________________

_____________________________________________________________________
3. Date (s) of misconduct: __________________________________________________________

4. Name (s) of victim(s) of the misconduct: _____________________________________________________

_____________________________________________________________________

5. Names of any witnesses of the misconduct: __________________________________________________

_____________________________________________________________________

6. Any information that may assist in the investigation of the complaint: ____________

_________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

____________________________________________________________________
Complaints should be submitted to a teacher, counselor, or principal.