Bullying Verified ? Yes ___ No ____ Remedial Action ( s ) Taken :________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ If Bullying Verified , Has Notification Been Made to Parents of Students Involved ? Parents ’ Names : _____________________________ Date Sent :______________ Parents ’ Names : _____________________________ Date Sent :______________ Parents ’ Names : _____________________________ Date Sent :______________ Parents ’ Names : _____________________________ Date Sent : ______________
If Bullying Verified , Have Invitation to Meetings Been Sent to Parents of Students Involved ? Parents ’ Names : _____________________________ Date Sent :______________
Parents ’ Names : _____________________________ Date Sent :______________ Parents ’ Names : _____________________________ Date Sent :______________ Parents ’ Names : _____________________________ 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 7 / 28 / 14
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