Request edit access
NISD Bully Reporting Form
Nacogdoches ISD prohibits bullying and retaliation against any person who in good faith makes a report of bullying, serves as a witness, or participates in an investigation.
Please complete the form below to report an incident of alleged bullying, harassment, or intimidation. If the bullying behavior you are reporting is an immediate threat to the safety of the target/victim, please call and report this behavior directly to the principal of the school as soon as possible.

Form revised 8-28-14 (reviewed 10-12-17)

MY INFORMATION:
I am a: *
Required
My Email Address is:
Optional - but recommended
Your answer
My Contact Phone Number is:
Optional - but recommended
Your answer
Victim's Information
*Required
Victim's Name *
Your answer
Victim's Grade *
Other Information:
Your answer
Bully's Information
*Required
Alleged Bully's Name *
Your answer
Alleged Bully's Grade *
Other Information:
Your answer
Incident Details and Additional Information
*Required
Date of Incident: *
MM
/
DD
/
YYYY
Campus where the incident occurred: * *
If the incident did not occur on a campus but was related to a school activity, what campus was being represented
Approximate Time of Incident *
Time
:
Location of Bullying
Please give us as much information as possible. What location needs to be watched?
Has this incident been reported to school personnel yet? *
Who was the incident reported to? *
Examples: teacher, counselor, nurse, vice-principal, principal, other...
Your answer
What did the alleged bully do to the victim? *
Please be as specific and detailed as possible.
Your answer
Were there any witnesses or bystanders? *
What were the names of the witnesses or bystanders?
If Known
Your answer
Additional Information (optional)
Your answer
Please affirm the statement below: *
The information provided on this form above is true and accurate to the best of my knowledge.
Required
Submit
Never submit passwords through Google Forms.
This form was created inside of Nacogdoches ISD. Report Abuse - Terms of Service - Additional Terms