Bullying Complaint Report Form
DISCLAIMER - Information from this form will be treated confidentially. We will only share this information with appropriate school personnel and law enforcement (if applicable.)
Bullying is a harmful behavior that is repeated, intentional, and involves an imbalance of power.
Victim Information
Please enter information about the victim below.
Victim's Name *
Your answer
Person Reporting Incident (Optional)
First and Last Name
Your answer
Phone Number of Person Reporting Incident (Optional)
xxx-xxx-xxxx
Your answer
Accused Information
Please enter information about the accused bully below.
Please enter information about the accused bully below. *
Your answer
Location of Incident *
Your answer
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident
Time
:
Possible reasons/alleged motives for the bullying incident: *
Required
Describe what happened in as much detail as possible. *
Your answer
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