Grand Blanc Academy Bullying Report Form
Please include all details when filling out this form. The incident will be investigated as soon as possible. If you need immediate assistance please call the office at 810-953-3140.
Name of Person Making This Report (First and Last Name)
Email Address for person making this report:
Who is doing the bullying or harassing? (provide name and grade):
Student(s) Being Bullied (provide name and grade):
Type of Harassment observed:
Please check ALL that apply:
Shoving / Pushing
Writing / Graffiti
Hitting / Kicking
Pressuring others to join in
Describe the incident (include time and location):
Names of witnesses present:
Is there any physical evidence? Check all that apply
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This form was created inside of Grand Blanc Academy.