DCPS Bullying Incident Report

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This form is designed to allow students, parents, and guardians to report incidents of bullying that they have witnessed or experienced. The purpose of this report is to provide our school community with a safe, supportive, and confidential way to share concerns about bullying.

Instructions:

Please complete as much information as you can regarding the incident.
This form can be filled out anonymously. If you wish to remain anonymous, you may leave the contact information fields blank. However, providing your contact information can help us if we need to follow up or gather additional details.
Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.

Name of the reporter/person filing the report: (can be anonymous)

Are you the target of the bullying?

Yes

N/A

Clear selection

Which of the following are you?

Student

Parent

Staff Member

Administrator

Other

Provide your contact information/telephone number. (can be anonymous)

Information regarding the incident. Please provide information such as date/time/location of the incident and names of the target/victim and aggressor(s). Please be as specific as possible.

Please provide the names of any witnesses who saw the incident or anyone that would have information regarding the incident.

Is their any additional information regarding the incident you would like to provide?

Submit

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