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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