Source: http://www.pacer.org/publications/bullypdf/BP-19.pdf
_____________________ (your street address)
_________________, ____ _________ (city, state zip code)
_________________, 2014 (date)
______________________ (name of Principal)
______________________ (name of school)
______________________ (school address)
______________________
RE: ____________________ (first and last name of child)
Dear ___________________, (name of Principal)
My child, _____________, (first name of child) is in the ____ (grade level) at _____________
(name of school). At school _____ (s/he) has been bullied and harassed by _____________
(name of harasser(s)). This has occurred on _____________ (date or approximate period
of time) when _________________ (describe as many details of the incident(s) as can be
recalled). When this happened ______________ (name of witness(es)) heard or saw it
and ___________________ (their response(s)). We became aware of this incident when
_____________________ (describe how you were notified).
_____________, (first name of child) was hurt by this bullying and harassment. _______
(S/He) had ___________________________________________________________(describe
physical injuries, emotional suffering and any medical or psychological treatment required).
_____ (Our/My) child has the right to be in a safe environment at school so _____ (s/he) can
learn.
Please send _________ (me/us) a copy of the District policies on bullying and harassment,
investigate this problem and correct it as soon as possible. Please let ______ (me/us) know, in
writing, of the actions you have taken to rectify the situation and to ensure it does not happen
again. I expect a response within 5 business days.
Thank you for your prompt attention to this serious problem.
Sincerely,
(sign in this area)
_______________________ (print your name)
CC: _____________________ (name of Superintendent of schools), Superintendent
(Sign and keep a copy for your records)
