Bullying Report Form (Per Policy 514)
Date of Event
Enter the date in which the event occurred.
Name of person(s) making this report.
Please enter the numbers with which we can contact you at.
Enter the e-mail address with which we can contact you at.
Please select one identifier below.
Employee (list position/school below)
Please provide the name/position of school staff and date that this information has been reported to previously, if applicable:
Please provide the name(s) and grades of all persons (including yourself, if applicable) who were the target of the discrimination, harassment or bullying.
Please provide the name(s) and/or descriptions of all individuals (students, school employees, school visitors or others) who engaged or participated in the alleged discrimination, harassment or bullying (if known).
Please provide the name of the school where the incident occurred.
Please describe the incident in detail.
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This form was created inside of JWP Public Schools.