Parent’s Name:

Parent’s Address:

Principal’s Name:

School Address:


Dear Principal: (insert name of school principal)

I am writing to report the bullying of my child, (insert child’s name, age and grade level). My child, attends (insert school name, school address, and if applicable teacher’s name).

Name, is a victim of constant bullying from fellow student, (insert child’s name), whose conduct has created an intimidating threatening and abusive educational environment. (Describe the actual problem with details of verbal expressions and physical conduct the victim suffered. Make sure to include names of witnesses, details of injuries, the effect of the conduct on the victim’s school work and the fear the victim suffers.

[Example: On date, name of your child sustained severe injuries after being assaulted by fellow student, name. Their teacher, name, had his back turned to the class when the fellow student attempted to staples my child’s finger to the desk. Because the staple was rusty and dirty, we had to take our son/daughter to the doctor and have medical documentation of the injury and the necessary tetanus shots. (Remember to include any documents which show the threats or harm suffered). Since the incident, name of bully continues to intimidate name of child and has threatened to attack him/her again. Last Thursday, during Science class, name of bully told my son/daughter, “I’m going to beat you up after school.” My child feels so threatened that he cannot concentrate in school and has lost focus on homework at home. He/she failed three subjects last semester and cries every day when I drop him/her off at name of school.

I understand that the school board must investigate these instances and ensure that they stop under Arkansas Ark. Code Ann. § 6-18-514 and (insert the name of the school’s anti-bullying policy). With the facts and evidence I listed above and enclosed for your convenience, it is my hope that your investigation will be discreet, commence as soon as possible, and not put my son/daughter in further danger.

Once the investigation has concluded, please provide me with a written copy of the investigation’s findings at (insert home or work address). Please contact me at (insert home, cell or work numbers and email if possible) to confirm when the report will be completed.

Thank you for your prompt assistance in this matter.


Parent’s name