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: ____________________________________________________________________________________________
Relationship of Reporter to Target( self, parent, teacher, peer, etc.): _____________________________________________________________________________________________ _____________________________________________________________________________________________
Report Filed Against:
_________________________________________________________________________ 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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