Student Conduct Form

Staff, students, and families are encouraged to report all concerns that might constitute a violation of the District's policy JICK: Pupil Safety and Violence Prevention - Bullying and Harassment.

All information will be routed to the appropriate Building Administrator / Designated Employee or SAU 70 Administrator for timely follow up.

Required

Namerequired

First Name

Last Name

Phone Number

Email Addressrequired

example@example.com

Did you directly witness the incident you are reporting?required

If you did not directly witness the incident please name witnesses here, if any are known:

Identity of allaged student and/or staff offender(s) (if known):

Identity of complainant(s) (person or people targeted by the behavior):

Date the alleged incident (if known):

Must contain a date in M/D/YYYY format

Time of the alleged incident (if known):

Please describe the witnessed or reported conduct of concern:required

Do you have any other information about the alleged conduct, separate from what outlined above? If, please outline here:

Please describe any initial actions you have taken to address the alleged conduct (notified police and / or DCF, etc.):

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Student Conduct Form