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