Remedial Action ( s ) Taken :________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________
If Bullying Verified , Has Notification Been Made to Parents of Students Involved ?
Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________
Date Sent :______________ Date Sent :______________ Date Sent :______________ Date Sent : ______________
If Bullying Verified , Have Invitation to Meetings Been Sent to Parents of Students Involved ?
Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________ Parents ’ Names : _____________________________
Date Sent :______________ Date Sent :______________ Date Sent :______________ Date Sent : ______________
Date of Meetings : _______________________________ _______________________________
If Bullying Verified , Has School Developed Student Safety Support / Intervention Plan ? Y
N
( Attach bullying complaint and witness statements . If bullying is verified , attach notification to parents of students involved , invitations to parent meetings , and records of parent meetings ).
Adopted : January 24 , 2012 Revised : March 27 , 2012 Revised : May 12 , 2015
59