JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
MHE Bullying Report Form
If a student mentions the word "bully" to you, please fill out this report form and Ms. Weiss or Mrs.
Betschart
will investigate the report.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Your Name
*
Your answer
Student's Name (bullied)
*
Your answer
Their Grade
*
Choose
K
1st
2nd
3rd
4th
5th
6th
Student's Name (bullying)
*
Your answer
Their Grade
*
Choose
K
1st
2nd
3rd
4th
5th
6th
Examples of what this student has done to the student being bullied:
*
Your answer
Where have these things happened?
*
Recess
Cafeteria
Hallway
Classroom
Specials or Double Specials
Other:
Required
How many times has this happened?
*
1 time
2-3 times
4 or more times
Are the students friends with each other?
*
Yes
No
Other:
Does it seem like this person has more power than the student being bullied? If yes, how?
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of DCSD.
Report Abuse
Forms
