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Bullying and Cyberbullying Report Form - MA
Please refer to Policy JICK and JICK-E1
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1. Name of complainant/reporter (by law, reports may be anonymous): However it is recommended so the situation can be addressed appropriately.
Your answer
Status of reporter:
*
Learner
Parent
School Employee
School Coach
School Advisor
Other:
Contact information for reporter: (Phone, Cell. phone, Email and mailing address)
*
Your answer
Name of alleged target(s):
*
Your answer
Name of alleged bully(ies):
*
Your answer
Relationship between alleged target(s)/bully(ies):
*
Your answer
Time(s) and location(s) of alleged incident(s):
*
Your answer
Name(s) of witnesses:
*
Your answer
Description of incident(s)in detail:
*
Your answer
I agree that the information on this form is accurate and true to the best of my knowledge and belief.
*
Yes
No
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