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High School Bullying Form
Where did the incident occur? *
What is the race of the victim?
Clear selection
What is the age of the victim? *
What is the gender of the victim? *
Date of Incident? *
MM
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DD
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YYYY
What type of harassment? *
Who was bullying, harassing, intimidating or causing harm? (Include first name, last name and grade if known.) *
Who was the person being harmed, bullied, harassed or intimidated? (Include first name, last name and grade if known.) *
Did you witness the bullying firsthand? *
Were there any other witnesses? If so, please list their names here:
Describe what happened. Give as much information as you can. *
Was law enforcement contacted? (If yes, who was contacted) *
Who is reporting this information? *
(OPTIONAL) What is your name?PLEASE NOTE: Anonymous reports are accepted however they must provide sufficient evidence to justify the commencement of an investigation. Formal disciplinary action may not be based on an anonymous complaint.
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