Report Bullying

Please complete the form below.

Who is making this report?

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Student

Parent / Guardian

Witness

Anonymous

Student who was bullied? *

Name and Grade

Answer required for "Student who was bullied? "

Student(s) involved (if known)

Name and Grade

Answer required for "Student(s) involved (if known)"

When did it happen?*

Date and Time

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How often did it happen

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One time

More than once

Where did it happen

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Classroom

Hallway

Cafeteria

Bus

Online

School Event

Other:

What type of bullying occurred?*

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Physical

Verbal

Social/Exclusion

Cyberbullying

Threats

Property Damage

Other:

What Happend?*

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Did the behavior

Answer required for "Did the behavior"

Cause physical or emotional harm

Make the student fear harm

Interfere with learning

Create an intimidating or hostile school environment

Disrupt the classroom or school

Were there Witnesses?

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Yes

Name of witness?

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Is there evidence?

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Screenshots

Photos

Video

Other:

Is anyone in immediate danger?*

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Yes

Is there anything else you'd like the school to know?

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Please fix the highlighted areas below before submitting.

Report Bullying