BRUNSWICK SCHOOL DEPARTMENT BULLYING REPORT FORM
Name of complainant/reporter (by law, reports may be anonymous):
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Anonymous
Status of reporter:
Contact information for reporter (if reporter is student, contact information for parent/guardian):
Phone
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Cell Phone
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Email Address
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Address
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Name of alleged target(s)
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Name of alleged bully(ies)
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Relationship between alleged target/bully(ies)
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Time(s) and location(s) of alleged incident(s)
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Names of witnesses
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Description of incident(s) - attach additional pages if more space is needed:
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I agree that the information on this form is accurate and true to the best of my knowledge and belief. *
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