Complaint of Bullying

 

The Amherst County Public Schools Code of Conduct states, A student, either individually or as a part of a group, shall not harass or bully others. Prohibited conduct includes, but is not limited to, physical intimidation, taunting, name-calling, and insults and any combination of prohibited activities. Prohibited conduct includes verbal conduct consisting of comments regarding to race, gender, religion, physical abilities or characteristics or associates of the targeted person, the principal and staff of this school are committed to enforcement of Code of Conduct and will respond promptly and appropriately to complaints of bullying. Any student can complain about bullying by talking to a n administrator and/ or completing this form and returning it to an assistant principal or principal. A copy of this form is also located in the school counseling department or main office.

 

PLEASE PRINT

 

Name of Student completing this form: _________________________________

School: ___________________________________________________________

 

 

Description of Incident (who, what, when, why, and how.) Use specific dates, times, locations, witness names, ect. if possible.

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

 

Signature of student completing this form: _______________________________

Date: ______________________________________________

 

Note: All complaints will be followed by an investigation. Those accused as well as the parents of students involved will be informed of complaints, witnesses will be interviewed, and all information will remain confidential except for that which must be shared as part of the investigation. By signing above, you are verifying that your statements are true and exact to the best of your knowledge.