Lakeview Junior High Bullying Report
Use this form to report a bullying situation or any other incident.
Information submitted will be seen by Mr. Dollahite, LJHS Vice Principal.
Bully's First Name
Bully's Last Name
Second Bully's First Name
Second Bully's Last Name
Victim's First Name
Victim's Last Name
Where did the incident happen?
Give a description of the incident.
Date and time of incident
What is your relationship to these people? Do you know these people?
Friend of Mine
Not a Friend of Mine
If you would like to give your name, type it below. You are not required to give your name.
Never submit passwords through Google Forms.
This form was created inside of Orcutt Union School District.
Terms of Service