Le Sueur-Henderson Public Schools Bullying Report Form
Taking the responsibility to report a dangerous or potentially harmful situation is commendable.
Before submitting a report we encourage you to consider speaking to a parent/guardian, a trusted adult or review your school resources. If speaking to someone directly is not an option, please use the Le Sueur Henderson Public Schools Bullying Report form.
Please be aware that reports submitted after school hours may not be viewed until the next school day.
If you are reporting an incident that is not school related, contact local law enforcement.
Person Reporting Incident
Please check the box describing the reporter
Close Adult Relative
School Staff Member
Name of alleged victim, if known
Name of alleged bully, if known
Date of Incident
Describe what happened as clearly as possible with as many details as you can remember.
Where did the incident happen?
School sponsored activity or event off school property
On the way to/from school
Electronically (internet, email, cell phone, etc)
Were there any witnesses? If yes, please list their names.
False Reporting Statement
LSH Schools do not tolerate intentional false reporting or any type of abuse to this service. This communication tool is intended to guarantee a safe, equitable learning environment for all students. The enrolled school reserves the right to forward any/all reports to law enforcement. Submitting a false report may be subject to disciplinary action if deemed necessary.
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