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