Request edit access
District #128 - Bullying, Harassment or Intimidation Reporting Form
Bullying can take various forms, including but not limited to: harassment, threats, intimidation, stalking, physical violence, sexual harassment, sexual violence, theft, public humiliation, destruction of property, or retaliation for asserting or alleging an act of bullying. Bullying is a serious offense, is contrary to state law and prohibited in Community High School District 128. Board policies 7:180, 7:20, 7:190 and 7:240 expressly forbid bullying in any form and describe procedures and consequences regarding such action. Bullying of any type should be reported immediately.
High School of Bullying Incident
Name
Your answer
E-mail Address
Your answer
Telephone Number
Your answer
I am a: (Check the appropriate box)
Name of alleged student victim (if known)
Your answer
Name of alleged offender(s) (if known)
Your answer
Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Where did this incident happen?
Describe what happened
Your answer
Has this incident been reported to anyone yet?
Who was the incident reported to?
Your answer
Were there any witnesses?
Names of witnesses
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of D128.org. Report Abuse - Terms of Service - Additional Terms