JICK-EC 

EXHIBIT

STUDENT  BULLYING / HARASSMENT /
INTIMIDATION

Lake Havasu Unified School District No. 1
2200 Havasupai Boulevard, Lake Havasu City, AZ 86403-3798
928.505-6900            FAX  928.505-6999            www.havasu.k12.az.us

Date:  ____________________________________

To:     ____________________________________
          (Parents of student being bullied)

From: ____________________________________
          (Principal)

RE:  Follow up on Harassment, Intimidation or Bullying Report

Your report dated _______________________ has been reviewed by School Administration and the following action has been taken:

____no action (unfounded)
____warning
____parent notification/conference
____detention
____suspension
____police involvement
____refer to mediation, counseling, Student Assistance Program
____tier 2 intervention
____other: _________________________________________________

Thank you for your help and involvement in this matter.  If you have any further questions please feel 
free to contact us at ________________________.
                                            Phone number