Bullying Report Form
Clinton Middle School is constantly looking to promote positive behavior and to bring an end to cases of bullying. This form may be used to report an incident of bullying behavior. While the form may be submitted anonymously, it would be helpful to the investigation process to have the names of all people involved including the name of the person submitting the form. We appreciate your assistance in helping us maintain a safe community of learning at Clinton Middle School.
Location where incident occurred:
Name of victim:
Your answer
Name of perpetrator:
Your answer
What happened?
Your answer
When did it happen? Please be specific by including date and time.
Your answer
How often is it happening?
Your answer
Are you afraid to come to school?
Your answer
Are there any witnesses? If so, who?
Your answer
Your name:
Your answer
Contact (phone/email):
Your answer
Submit
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