Table of Cont . Grad . Req . Disciplinary Responibilities Stud . Activities School Services Miscellaneous
Administrative Investigation Notes ( use separate sheet if necessary ):
Bullying Verified : Yes ____ No _____ Teen Dating Violence Verified ? Yes _____ No _____
Remedial Action ( s ) Taken :
If Bullying or Teen Dating Violence Verified , Report Sent to Parents of Students ?
Parents ’ Names : |
Date Sent : |
Parents ’ Names : |
Date Sent : |
Parents ’ Names : |
Date Sent : |
Parents ’ Names : |
Date Sent : |
( Attach bullying complaint , or teen dating violence complaint , witness statements , and notification to parents of students involved if bullying / teen dating violence is verified )
Rev . 5 / 2022
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