Globe Unified School District-Bully Form

Every student should experience a positive school environment. Please use the link below to let us know of a student concern regarding bullying, personal safety, harassment, intimidation, equal access, discrimination, or student rights.

What is Bullying?

Please complete the information below to submit your concern. A report must be made within thirty calendar days of the time of the incident.

A student’s parent or guardian may complete this form.

The student will be contacted within two school days.

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Phone Number

Best phone number? Format: (000) 000-0000.

Best time to reach you?

Hour Minutes

AM/PM Option

Email

example@example.com

Name of person, school, department, program, or activity you wish to complain against?

What is your complaint? Describe the incident/situation. Where did it occur? When? Who is involved? What led up to this problem? Have you tried to solve this problem? If yes, how? Be sure to note dates, times, and places.

Is there anyone who could provide more information regarding this complaint? If so, please list name(s) and contact information.

What do you think can and should be done to solve this problem?

WHAT HAPPENS TO THIS COMPLAINT?

Thank you for sharing your concerns. We will contact you within two school days.