Bullying-Harassment Reporting Form

Bullying-Harassment Reporting Form

If you have information regarding bullying or harrassment and would like to report this information anonymously, please fill out the following form to the best of your knowledge. This form will be submitted to the person you choose for follow up. If you fear that a student is in IMMEDIATE danger, contact the school principal or the local police.

1. *Name of person(s) being bullied or harassed (first and last name)

2. Name of person(s) doing the bullying/harassing (first and last name)

3. Where did the incident occur?

4. When did the incident occur? (Date and Time)

5. Please describe, in as much detail as possible, what happened.

6. Do you know of anyone else who saw or heard what happened? If so, please provide as much detail as possible about these people.

7. Have you spoken to anyone about this incident? If yes, who?

8.  *Send this submitted for to: 

Once sumbitted, the investigation of this report will begin promptly.  This matter will be handled as confidentially as possible.

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