Anonymous Bullying Form
This form is anonymous and confidential. It should only be used when you are feeling a real concern for the physical, social or emotional well-being of yourself or a fellow student. Upon submission of this form a request will be sent anonymously to the building counselor and principal. If you feel this is an emergency, we encourage you to report this immediately to a trusted adult.
Please type the name of the student that you are concerned about. *
Your answer
Where did the incident that you are reporting happen?
Your answer
Please describe the problem or incident that you witnessed/heard that you are concerned about. *
Your answer
What is the approximate date and time this incident occurred?
How often is this occurring?
If you would like to leave your name, please do so below. This is optional.
Your answer
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