Bullying Anonymous Reporting Form

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If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge. Please note, this form is completely anonymous, we do not collect your emails. For the purpose of this form, bullying encompasses harassment, intimidation, and bullying.

Full name of person being bullied:

Full name of person being a bully:

Date of incident:

YYYY

Type of bullying:

Physical

Emotional/Social

Damage to property

Online

Other:

Clear selection

Where did the incident occur?

Please describe, in as much detail as possible, what happened.

Did others see this take place?

Person reporting the incident (OPTIONAL). Please use your full name.

May we contact you for more information on this incident? *

Yes

Submit

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This form was created inside of Elida Municipal Schools.