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Introduction to the Anonymous Bullying Complaint Report Form
Students, parents and any member of the Winthrop community can anonymously report bullying by completing the complaint form below. Reports will be forwarded via email directly to the appropriate building principal for investigation. Reports may be made anonymously; however, adding more information to the report will aid the principal in dealing with the report more effectively. Room has been provided on this reporting form for the reporter to include his or her name and contact information. The Winthrop Public Schools will fully investigate all reports, anonymous or otherwise, and will notify parents of both the target and the aggressor, as required by law. However, no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.

Anonymous Bullying Complaint Form
(FORT BANKS SCHOOL)
      
Reporter Information (Optional, but helpful if provided)
Name of Reporter/Complainant:
Indicate whether you are a: Target   Reporter (not the target)
Indicate whether you are a: Student Staff Member Parent Administrator
Phone number (Optional):
School: Grade:
    
Information about the Incident:
Name of Target: Student Staff Other
Name of Aggressor: Student Staff Other
Date(s) of Incident:
Time of Incident(s):
Location of Incident(s):
     
Witnesses: (Anyone who saw the incident or has relevent information)
Name:      Student Staff Other
Name:  Student Staff Other
Name:   Student Staff Other
        
Please, DESCRIBE the details of the incident below. Be sure to INCLUDE the names of all the parties involved, what occured, i.e who did what to whom, and include specific words/threats and language used.
Description of the Incident:
     
Signature of Reporter/Complainant: ONLINE NO SIG REQUIRED Date:
     

 






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