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SPRINGBOROCOMMUNITYCITYSCHOOLS

HARASSMENT,INTIMIDATIONORBULLYING
COMPLAINTFORM
NameofPersonFilingComplaint:_________________DateFiled: _______
NameofVictim: _________________________________________________
DateofIncident:___________________TimeofIncident: _______________
LocationofIncident:______________________________________________
DescriptionofIncident(includenamesofallinvolved):
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________
________________________________________________________________

Usethebackofthisformifmorespaceisneeded.
WitnessestotheIncident: _________________________________________
________________________________________________________________
________________________________________________________________
Allcomplaintsshouldbepromptlyforwardedtothebuildingprincipal.
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