LCMS Bullying Report
At Louisa County Middle School, we strongly believe that each student deserves to feel safe at school. LCMS enforces a "no Bullying" policy, and we need your help in enforcing that policy. Please complete this form to report any problem that you are having or are observing bullying behavior while you are at school or on the bus. It is very important that detailed information is given so that action can be taken. You can also tell an adult about any bullying you may have experienced or witnessed. Either way, your information will be kept private. IF THIS IS AN URGENT MATTER, DO NOT SUBMIT HERE ALONE. INFORM YOUR PRINCIPAL, TEACHER, OR SCHOOL RESOURCE OFFICER IMMEDIATELY. IF THIS IS AN EMERGENCY, DIAL 911.
Who is being bullied? *
Your answer
What grade is this student in?
Who is the student that is bullying?
Your answer
When did this start?
Your answer
When did this last happen?
Your answer
Where did this happen? *
Check all that apply.
Required
Has this incident been reported to anyone yet? *
If the incident has been reported already, who was the incident reported to and when was it reported?
Your answer
Who else knows about the incident?
Your answer
If you can be contacted regarding this report, please provide your name and contact information.
This is optional. Any information given will be kept confidential.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Louisa County Public Schools. Report Abuse - Terms of Service - Additional Terms