KMS Bullying Report Form
Click "Submit" to send the information after you answer the questions below. Your report will go directly to the school counselors and the Student Services Department. Your information will be kept confidential.
Name of person being bullied. *
Please include first and last name if you know the person's full name.
Name of person doing the bullying.
Please include first and last name if you know the person's full name.
Where did the bullying occur?
Check all that apply.
When did this happen?
Date and Time
Type of bullying.
Check all that apply.
Please add any additional information that will be helpful in understanding what happened and who was involved.
Have you reported the bullying to another adult at school?
If so, include their name.
Name of student(s) being an ally.
An "ally" is someone who stands up against bullying and/or who helps others in need.
Your name. (Optional)
I am a
Clear selection
Did you witness the bullying?
Clear selection
Who else witness the event?
Submit
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