Code No. 104.E3
DISPOSITION OF ANTI-BULLYING/HARASSMENT COMPLAINT FORM
Name of complainant:
Name of student or employee target:
Grade and building of student or employee:
Name and position or grade of
Alleged perpetrator/respondent
Date of initial complaint:
Nature of discrimination or harassment alleged (Check all that apply)
Summary of investigation:
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Signature:
Date:
Updated 2-18-2019 Reviewed 7-25-2022