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2018-19 Bullying Report Form
This form is intended for the purposes of reporting bullying involving any Lowell Middle School students. Reporting can be done anonymously. All reports will be investigated. Please provide as much factual detail as possible when making reports. False reporting is unethical, and school administration will also investigate the source of false reports.

The state of Indiana defines Bullying as using an imbalance of power:
Repeatedly,
On purpose,
To harm another person(s) (physically, socially, emotionally)

I am a... *
Name of Reporter (optional)
Your answer
Name of Bully *
Your answer
Name of person being bullied *
Your answer
Where and when is the bullying occurring? (Please list specific times and places) *
Your answer
Please provide any additional information that would be helpful (grade level, team, previous issues between students, etc.)
Your answer
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