Challenging Behavior Reporting Form

Please list the name(s) of the offender(s):

Please describe what happened?

Of the following statement(s), check any that may describe or include what happened:

Do you believe that the reported instance(s) of challenging behavior was in reference to a student's perceived or actual age, ancestry, color, learning disability, marital status, intellectual disability, national origin, physical disability, mental disability, race, religion, creed, sex, gender identity or expression, sexual orientation, and status as a veteran? If so, why?

If known, provide the name(s) of any witness(es) of the alleged incident:

This form does not modify or eliminate any rights or obligations under state and federal laws, including any constitutional and civil rights protections, or any applicable policies and procedures or collective bargaining agreements. All students' private and personal information will remain confidential throughout this process, subject to any waiver rights or disclosure responsibilities as permitted or required by law.

Please note: when a student exhibits challenging behavior, our priority is to ensure the safety of the students and the school, and to work with the student(s) to prevent the recurrence of such behavior, including making amends for any challenging behaviors that occurred. Federal law protects the privacy of each student. Therefore, you cannot be provided with any specific information concerning the student alleged to have engaged in the challenging behavior.