Cyberbullying  Form
If you are, or know of someone who is, the victim of cyberbullying, hacking, or other related issues please contact Mr. Painter for immediate action.  Please check out this (http://www.stopbullying.gov/cyberbullying/how-to-report/) resource for information on how to respond to cyberbullying.
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1. I am a:
 During this incident I was a:

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What is your name?
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If you are a student what grade are you in?  
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What is the name of the student you would like to report?
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 If you do not know the name of the student, please describe the person.

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Where did this incident take place?
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Please describe the incident.
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Were there witnesses to this incident
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What are the names of the witnesses?
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Please rate the severity of this incident from your perspective.
(optional) 1 being minor incident but unacceptable to 5 being major incident, could result in retaliation or violence.
Please describe the frequency with which this type of incident occurs.
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How do you feel about this incident or person?
(optional) (Examples: they are annoying, I hate them, I want to hurt them, they don’t make me mad I just want it to stop…etc)
 Did this or other incidents make you feel like harming yourself or others?
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Would you like to speak with a counselor?
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What else would you like us to know about this incident?
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