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Cleveland Public School Bullying and Harassment Reporting Form
Fill out the form below to file a report.
Here are other additional resources on bullying:
Stopbullying.gov
pacer.org/bullying
education.com/topic/school-bullying-teasing
Email address *
Today's Date *
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Persons name making the report. *
Your answer
Telephone number for the person making the report. *
Your answer
Please check the box describing the reporter. *
Required
Name of the person responsible for bullying, harassing, intimidating, or causing harm. *
Your answer
First and Last name of targeted student or staff member. *
Your answer
Date of incident *
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Incident time *
Time
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What type of incident are you reporting? *
Describe in detail what occurred, when it occurred, where it occurred, and who was involved. *
Your answer
Please share the name of witnesses if there were any. *
Your answer
How many times has this situation occurred? *
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