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Brooklyn Schools Bullying, Harassment, or Intimidation Form
If you suspect a child you are aware of is being harassed, bullied or intimidated please fill out the below form. Upon  completion of the form, please notify either the Elementary or Middle School depending on where the child attends through phone call or email immediately.  
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Email *
Today's Date
Person Reporting the Incident (Please include contact information)
The person reporting this incident is... *
Name of alleged student victim, age and school
Name(s) of alleged witnesses (if known) including age and school
Name(s)of alleged offender(s) (if known) including age and school
Where did the incident happen
Check the statement(s) that best descries what happened (choose all that apply)
Did physical injury result from this incident?
Clear selection
Additional Pertinent Information that you would like the investigator to know
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