Beach Park Middle School Bullying Report Form
Beach Park School District maintains a firm policy prohibiting all forms of bullying.  Everyone is to be treated with respect and dignity.  Bullying by any student, teacher, administrator, or other school personnel which creates an intimidating environment will not be tolerated under any circumstance.  Reports will be reviewed and handled by the Principal the following school day.  If you would like to contact the Principal by phone, please call 847-596-5860.

*Only use this form to report issues relating to racism, bullying, cyber-bullying, or harassment*
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Your Name.  Please understand, without providing your contact information it may be difficult to pursue this report. *
I am:
If parent, please provide your child's name.
Contact number where you can be reached (Optional but Helpful)
Please describe the incident:
Include information on the bully, victim, any witnesses/bystanders; the more detail the better
Location:
Other location:
Time
Time
:
Date
MM
/
DD
/
YYYY
What sort of help would you like to see as a result of this issue (optional)?
Have you notified anyone else of this issue? If yes, who?
Additional Information:
Thank you for submitting a report, if you provide contact information someone will be in touch shortly.  
*BPMS Bullying School Bullying Form Template # WkMYAZc5SBhy
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