ENFIELD PUBLIC SCHOOLS
FORM A
REPORT OF SUSPECTED BULLYING BEHAVIORS OR TEEN DATING VIOLENCE
(School Employees Should File with the School Principal)
(Parents and Students May File with the School Principal or Any Other School Employee)
Name of Person Completing Report: _______________________________________________
Date: __________________
Target(s) of Behaviors/Violence:
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Relationship of Reporter to Target (self, parent, teacher, peer, etc.):
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Report Filed Against:
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Date of Incident(s): _____________________________________________________________
Location(s):________________________________
Time: __________________
Describe the basis for your report. Include information about the incident, participants, background to the
incident, and any attempts you have made to resolve the problem. Please note relevant dates, times and
places.
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