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Bully Box - All Information Is Confidential
"See a bully, hear a bully, report a bully!" At Van Nuys Middle School, we take bullying seriously.

Are you being teased or hurt? Is someone using force on you to get their way?

Student Last Name (victim) *
Your answer
Student First Name (victim) *
Your answer
Victim's Grade *
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Phone Number *
Your answer
Parent/Guardian Email
Your answer
Name of Bully *
If you do not know the bully's name, please tell us what class you share or other helpful information.
Your answer
Bully's Grade *
What happened? *
Although difficult at times, please be very specific as to the actions and words of the bully.
Your answer
Were there other student(s) with you? Please type their first and last names.
Your answer
How long has this been going on?
(Days, weeks, etc.)
Your answer
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