Report Form for Bullying
To be completed by the bullying target, witness, or person with information about an incident of bullying.

Bullying may take various forms, including but not limited to harassment, threats, intimidation, stalking, physical violence, sexual harassment, sexual violence, theft, public humiliation, destruction of property, or retaliation for asserting or alleging an act of bullying.
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Email *
Crete-Monee School District 201-U School Location *
First Name
Last Name
Do you prefer to stay anonymous? 
Date of Report *
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Are you a:
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Are you the target of the bullying that you are reporting?
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Date of Incident
MM
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DD
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YYYY
Time of Incident
Time
:
Is this a repeated incident?

*If Yes, please list the additional incident(s) information in the summary at the end of this form. 
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Person(s) being reported as targets of bullying: *
Person(s) being reported as aggressors engaged in bullying: *
Person(s) who witnessed the bullying:
Was the incident based on any of these actual or perceived characteristics?
Student(s) were targeted for bullying in the following way(s). Check all that apply.
Student(s) were targeted for bullying in the following place(s): (Check all that apply.)
Please tell us about the incident in your own words. Try to include anything important that you haven’t already shared. What happened before the incident? What exactly took place? How did people respond, and what happened right after? If you remember, include anything that was said or done, and how it made you or others feel.
A copy of your responses will be emailed to the address you provided.
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