School Violence/Bullying Complaint Form
Your Grade
Please answer the following questions about the most recent incident:
Date of incident
Time of incident
Location of Incident
Perpetrators List the name(s) of the alleged perpetrator(s):
Relationship Relationship between you and the alleged perpetrator:
Incident Describe the incident:
Witnesses Were there any witnesses?

Who If yes, who?
First Incident Is this the first incident?

Number of Incidents If no, how many times has it happened before?
Other Information Other Information, including previous incidents or threats:
The mission of the Burton Independent School District is to provide the highest quality education possible to meet the individual needs of all students, emphasizing academic and life skills in a motivating, disciplined, nurturing environment through a collaborative effort among District personnel, students, parents, and the community.

Copyright ©  2016 - Burton Independent School District

powered by ezTaskTitanium TM