RISING STAR ISD BULLYING/Cyberbullying/THREAT of VIOLENCE Report Form

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Parent/Student Bullying/Cyberbullying/Threat of Violence Report Form

Please use this form to submit reports of bullying incidents or known threats of violence to the administration of Rising Star ISD.

*IF THERE IS AN IMMEDIATE THREAT OR DANGER, PLEASE CALL 911

I am reporting the following concern(s): *

Bullying/Cyberbullying

A threat of violence has been made against myself, another student, or a faculty member

A threat of violence has been made against a school in Rising Star ISD

Other: ________________________________________________________

Required

Alleged Victim:

Alleged Perpetrator:

School:

Date and Time of Incident:

Location of Incident:

Was social media used: (if yes, please describe; otherwise answer no)

Please give a brief summary about the incident:

Name(s) of witnesses (if applicable):

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