Peer Conflict Form

Reports may be made anonymously, but no disciplinary action will be taken against the alleged aggressor solely on the basis of an anonymous report. For that reason, you are encouraged to place your name with this document, so you can be contacted for further information if required.
Peer Conflict Form
Your name:  
Are you the (select one):
Name of targeted student(s):  
Name(s) of aggressor(s) (person or persons engaging in inappropriate behavior:  
Date(s) of incident(s). Be as specific as possible:  
Location of the incident(s). Be as specific as possible: 
Please list the names of anybody who witnessed the incident(s) or can provide information:
Describe the details of the incident(s), including names of those involved, what occurred, and what was said or done.  Include specific phrases if possible.  
















I hereby certify that to the best of my knowledge the above-mentioned information information is true accurate, and complete. Making false allegations is a violation of the procedures followed at EJSHS and is subject to disciplinary action itself.


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