Bullying/Inappropriate Behavior Report Form

 

"*" indicates required fields

Your Name (OPTIONAL)
MM slash DD slash YYYY
Seperate names with commas, as needed
Name of Bullying Victim*
Is This the First Time You or the Victim have been Bullied/Harassed*
If No, Is the Bullying Incident by the Same Person(s) or a Different Person(s)?*
Where Did the Incident Occur*

MM slash DD slash YYYY
Choose the Statement(s) that Best Describe What Happened*

Were There Any Witnesses*
Seperate each name with a comma
Clear Signature

Thank You

This information will be looked into immediately. If you fear that a student is in IMMEDIATE danger, please immediately report the incident to an administrator.

This form should be used to report a possible incident of bullying. Anyone can report bullying or harassment by talking to a teacher or administrator or by completing this confidential form. By completing this form you are indicating that your comments are true and exact to the best of your knowge. All reports of bullying are taken very seriously and wil be investigated.

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