Anonymous Bullying Report
False reporting will be handled as a disciplinary issue.
What school do you attend? *
1. Who is doing the bullying? (give first and last name of individuals if possible) *
Your answer
2. Were there any witnesses? (give first and last names of individuals, please) *
Your answer
3. What day(s) did the bullying happen? Provide day(s) and/or date(s). *
Your answer
4. Was there a threat made? *
5. If you answered yes to #4, describe the threat:
Your answer
6. What happened?
7. How many times has it happened?
8. Where did it happen? *
9. Have you ever, before now, reported this to any adult in the school? *
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