School Bullying Complaint

SCHOOL BULLYING FORMAL COMPLAINT

Table of Contents

1. Complainant and Student Information
2. School Information
3. Description of Bullying
4. Prior Reports and School Response
5. Federal Civil Rights Claims
6. Relief Requested
7. Declaration
8. State-Specific Notes
9. Practitioner Checklist

FORMAL COMPLAINT OF BULLYING AND HARASSMENT

Filed with:
☐ [SCHOOL NAME] Principal: [NAME]
☐ [SCHOOL DISTRICT] Superintendent: [NAME]
☐ [STATE EDUCATION AGENCY]
☐ U.S. Department of Education, Office for Civil Rights (OCR)
☐ Other: [________________________________]

Date: [__/__/____]

I. COMPLAINANT AND STUDENT INFORMATION

Parent/Guardian Name: [________________________________]

Address: [________________________________]

City, State, ZIP: [________________________________]

Telephone: [________________________________]

Email: [________________________________]

Student Name: [________________________________]

Date of Birth: [__/__/____]

Grade: [____]

School: [________________________________]

Disability Status (if applicable):
☐ Student has an IEP under IDEA
☐ Student has a Section 504 Plan
☐ Student has a disability but is not currently identified
☐ N/A

II. SCHOOL INFORMATION

School Name: [________________________________]

Principal: [________________________________]

School District: [________________________________]

Superintendent: [________________________________]

Anti-Bullying Coordinator / Designated Contact (per state law): [________________________________]

Title IX Coordinator (if applicable): [________________________________]

III. DESCRIPTION OF BULLYING

Nature of Bullying Conduct

The student has been subjected to the following types of bullying:

☐ Physical Bullying: hitting, kicking, pushing, tripping, spitting, damaging property
☐ Verbal Bullying: name-calling, threats, insults, slurs, taunting
☐ Social/Relational Bullying: exclusion, spreading rumors, public humiliation
☐ Cyberbullying: harassment via text, social media, email, or other electronic means
☐ Sexual Harassment: unwelcome sexual comments, touching, or conduct
☐ Bias-Based Bullying: targeting based on:
☐ Race or ethnicity
☐ National origin
☐ Sex or gender
☐ Sexual orientation
☐ Gender identity
☐ Disability
☐ Religion
☐ Other: [____]

Detailed Incident Log

Incident 1:

• Date: [__/__/____]
• Time: [____]
• Location: [________________________________]
• Description: [DETAILED ACCOUNT OF WHAT HAPPENED]
• Perpetrator(s): [NAME(S), if known]
• Witnesses: [NAME(S)]
• Evidence: [DESCRIBE — screenshots, photos, video, written materials]
• Reported to school? ☐ Yes (Date: [____], Person: [____]) ☐ No

Incident 2:

• Date: [__/__/____]
• Description: [________________________________]
• Reported? ☐ Yes ☐ No

Incident 3:

• Date: [__/__/____]
• Description: [________________________________]
• Reported? ☐ Yes ☐ No

[CONTINUE AS NEEDED]

Impact on the Student

The bullying has caused or contributed to:
☐ Fear of attending school / school refusal
☐ Decline in academic performance (provide grades/evidence)
☐ Physical injuries: [DESCRIBE]
☐ Emotional distress: anxiety, depression, PTSD symptoms
☐ Self-harm or suicidal ideation
☐ Sleep disturbances
☐ Social withdrawal / loss of friendships
☐ Need for counseling or therapy
☐ Transfer to another school
☐ Other: [DESCRIBE]

IV. PRIOR REPORTS AND SCHOOL RESPONSE

Reports Made

School's Response (or Lack Thereof)

☐ School took no action after receiving reports
☐ School investigated but found the complaint unsubstantiated (despite evidence)
☐ School imposed inadequate discipline that did not stop the bullying
☐ School failed to follow its own anti-bullying policy
☐ School failed to implement a safety plan for the targeted student
☐ Bullying continued or escalated after reports were made
☐ School retaliated against the student or parent for reporting
☐ School suggested the student transfer schools rather than addressing the bully
☐ Other: [DESCRIBE]

V. FEDERAL CIVIL RIGHTS CLAIMS

Title IX (Sex-Based Harassment) — 20 U.S.C. § 1681

☐ The bullying constitutes sex-based harassment, and the school had actual knowledge and responded with deliberate indifference. See Davis v. Monroe County Bd. of Ed., 526 U.S. 629 (1999).

Title VI (Race/National Origin Harassment) — 42 U.S.C. § 2000d

☐ The bullying constitutes race- or national origin-based harassment in a federally funded program, and the school failed to take effective action.

Section 504 / ADA (Disability Harassment) — 29 U.S.C. § 794 / 42 U.S.C. § 12132

☐ The bullying targets the student's disability, and the school failed to address it, denying the student equal access to education.

☐ The bullying has caused a need for additional accommodations or services under the student's IEP/504 Plan that the school has failed to provide.

42 U.S.C. § 1983 (State-Created Danger / Deliberate Indifference)

☐ School officials, acting under color of state law, were deliberately indifferent to known bullying that posed a substantial risk of harm, creating or increasing the danger to the student.

VI. RELIEF REQUESTED

☐ Immediate investigation of the bullying under the school's anti-bullying policy
☐ Disciplinary action against the perpetrator(s)
☐ No-contact order / separation of the student and perpetrator(s)
☐ Safety plan for the targeted student
☐ Counseling services for the student at the school's expense
☐ Academic accommodations (tutoring, grade adjustments, deadline extensions)
☐ Revision of IEP/504 Plan to address bullying-related needs
☐ Staff training on anti-bullying policies and procedures
☐ Monitoring of compliance by the school district
☐ OCR investigation and compliance review
☐ Compensatory damages (if filing in court)
☐ Injunctive relief requiring policy changes
☐ Attorney's fees (under applicable federal civil rights statutes)
☐ Other: [DESCRIBE]

DECLARATION

I declare under penalty of perjury that the foregoing is true and correct to the best of my knowledge, information, and belief.

Signature: _______________________________

Printed Name: [________________________________]

Date: [__/__/____]

STATE-SPECIFIC NOTES

California

• Statute: Cal. Educ. Code § 234.1 (anti-bullying policy requirements); § 48900(r) (bullying as grounds for suspension/expulsion)
• Cyberbullying: Cal. Educ. Code § 48900(r) covers cyberbullying
• Seth's Law: Cal. Educ. Code § 234–234.5 (requires anti-bullying policies and complaint procedures)

Texas

• Statute: Tex. Educ. Code § 37.0832 (David's Law — anti-bullying and cyberbullying; school must notify parents of both victim and perpetrator)
• Cyberbullying: Tex. Penal Code § 42.07(a)(7) (criminal cyberbullying of a minor)
• Transfer: Student may transfer to another campus if bullying victim (Tex. Educ. Code § 25.0341)

Florida

• Statute: Fla. Stat. § 1006.147 (Jeffrey Johnston Stand Up for All Students Act — comprehensive anti-bullying policy requirements)
• Cyberbullying: Covered under Fla. Stat. § 1006.147
• Reporting: Schools must report bullying incidents to parents within 2 school days

New York

• Statute: N.Y. Educ. Law § 10-18 (Dignity for All Students Act — DASA)
• Cyberbullying: Covered under DASA
• Reporting: Material incidents must be reported to the Commissioner of Education
• Coordinator: Each school must designate a Dignity Act Coordinator

PRACTITIONER CHECKLIST

☐ Documented all bullying incidents with dates, witnesses, and evidence
☐ Preserved electronic evidence (screenshots, texts, social media posts)
☐ Reviewed the school district's anti-bullying policy
☐ Confirmed all prior reports to the school and documented responses
☐ Identified protected-class basis for federal civil rights claims (if applicable)
☐ Filed OCR complaint within 180 days if federal civil rights violation
☐ Assessed whether IDEA/504 protections apply (disability-related bullying)
☐ Requested IEP/504 meeting if bullying affects student's educational program
☐ Obtained medical/counseling records documenting harm to student
☐ Reviewed state-specific anti-bullying statute requirements
☐ Assessed state tort claims (negligent supervision, IIED)
☐ Considered reporting to law enforcement if criminal conduct involved

SOURCES AND REFERENCES

• Davis v. Monroe County Bd. of Ed., 526 U.S. 629 (1999) — student-on-student harassment under Title IX
• Dear Colleague Letter, U.S. DOE OCR (October 26, 2010) — harassment and bullying
• U.S. DOE, Stopbullying.gov — federal anti-bullying resources
• State anti-bullying laws — all 50 states have enacted anti-bullying legislation (see stopbullying.gov/resources/laws)