Washburn Bullying Report Form
Name of Complainant/reporter
optional: by law, reports may be anonymous
Status of Reporter
Contact information for reporter (if reporter is student, contact information for parent/guardian)
Reporter phone number
Name(s) of alleged target(s)
Name(s) of alleged bully(ies)
Relationship between alleged target(s)/bully(ies)
Time(s) and location(s) of alleged incident(s)
Names of witnesses
Description of incident(s)
By submitting this form, I agree that the information I have provided is accurate and true to the best of my knowledge and belief.
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