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STUDENT HARASSMENT COMPLAINT STATEMENT FORM Name of Student being harassed: Name of school student is attending: Name of person filing statement: Complainant Charged Person Witness Please state specifically
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How to fill out student harassment complaint statement

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How to fill out a student harassment complaint statement?

01
Begin by gathering all necessary information: Before filling out the complaint statement, make sure you have all the relevant details related to the incident. This includes the date, time, location, and names of those involved in the alleged harassment.
02
Provide your own personal information: Start the complaint statement by including your full name, contact information (phone number, email address), and any relevant identification numbers such as your student ID.
03
Describe the incident: Clearly and objectively describe the incident of harassment. Be specific about what happened, who was involved, and any witnesses present. Stick to the facts and avoid including any personal opinions or assumptions.
04
Include any evidence: If you have any evidence supporting your complaint, such as text messages, emails, or photos, make sure to attach copies to the complaint statement. Clearly label and describe each piece of evidence.
05
Provide a timeline: Outline a timeline of events leading up to and following the incident. Include any previous incidents or interactions that may be relevant to understanding the context of the harassment.
06
State the impact: Explain how the incident has personally affected you academically, emotionally, or physically. Describe any changes in your behavior, sleep patterns, or overall well-being as a result of the harassment.
07
List any previous actions taken: If you have already taken any actions regarding the harassment incident, such as discussing it with a teacher, counselor, or filing a previous complaint, make sure to mention it. Include any supporting documentation or evidence related to these previous actions.

Who needs a student harassment complaint statement?

01
Students who have experienced harassment: Any student who has been a victim of harassment, whether it be verbal, physical, or online, may need to fill out a student harassment complaint statement.
02
Parents or guardians of the affected student: If the student is a minor, their parents or guardians may need to assist in filing the complaint statement or even file it on their behalf.
03
School administrators or officials: The complaint statement is typically required by school administrators or officials who are responsible for investigating and addressing incidents of harassment within the educational institution.
Remember that each school or institution may have specific procedures and guidelines for filing a student harassment complaint statement. It is important to familiarize yourself with these guidelines and follow them accordingly to ensure a thorough and effective resolution to your complaint.
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The student harassment complaint statement is a formal document that describes any incidents of harassment or discrimination against a student.
Any student who has experienced harassment or discrimination is required to file a student harassment complaint statement.
The student can usually fill out the complaint form provided by the school or institution, detailing the incident and any relevant information.
The purpose of the student harassment complaint statement is to document and address instances of harassment or discrimination in educational settings.
The student must report the details of the harassment incident, including dates, times, and witnesses, as well as any impact it had on them.
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CERTIFIES Complainant harassed

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