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San Leandro High School is committed to end bullying. In order to assist our efforts, Board Policy 5131.8 has established guidelines to report and investigate bullying, affirming that every student and staff member has a right to a safe learning environment. If you need to report a bullying incident, please complete the “Bullying Report Form” (E (1) 5131.8) by clicking on the link below to download the form and returning it to an administrator. If you need any assistance please contact an administrator.
SAN LEANDRO UNIFIED SCHOOL DISTRICTBULLYING REPORT FORM
E(1) 5131.8
Complaints shall be investigated in a manner that protects the confidentiality of the parties as appropriate. Submission of this report form is encouraged; however oral reports shall be considered official reports.Reports maybe made anonymously, but formal disciplinary action may not be based solely on an anonymous report.
Section I: Initial Notification of the Incident or ComplaintName of Student making report
Date of Report
Parent/Legal Guardian/Community member (Filing this complaint on behalf of a student)
Person(s) your complaint involves:
Date(s) of Incident:
Where did the incident take place?
Section II: Investigation of Incident or Complaint
Did you report this incident of bullying? Yes No
If yes, to whom?
When?
Please describe your complaint in as much detail as possible. (Use extra sheets of paper if necessary.)
Attach any documents related to this complaint.Section III: Actions and Consequences/Discipline
Complainant (person making complaint) informed about results of investigation and actions to betaken, and counseled about reporting any future recurrence or attempts at retaliation. Yes No
If no, explain:
Appeal process described to victim’s parent/legal guardian. Yes No
If No, explain:
Harasser(person who complaint is made against) informed about retaliation and disciplinary action if incident recurs. Yes No
If no, explain:
Section IV: Resolution
Disposition Substantiated
Unsubstantiated
Partially Substantiated
Signature
Date
Please submit this form to the school principal.If you need assistance completing this form, contact the school principal. Complaints will be investigated and resolved within 30 school days of receipt of this form. (Forward copy to Student Support Services).
Exhibit SAN LEANDRO UNIFIED SCHOOL DISTRICT
Approved: July17, 2012 San Leandro, CaliforniaApproved: October 16, 2012Download a copy of the form by clicking HERE
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