Harassment/Bullying Report

Students or parents may use this tool to report any form of harassment or incident. Please reference our district policy concerning Bullying and Harassment for additional information. This information is sent directly to the building principal.

ALL REPORTS WILL BE KEPT STRICTLY CONFIDENTIAL!!!!!!!

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Student's name involved/being harassed: *
Date of Report: *
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Date of Alleged Incident: *
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Location of Alleged Incident (please be as specific as possible): *
Name of alleged harasser: *
Description of Incident(s)(Please be as specific as possible): *
Name of Witness(es), if any: *
Your name (this is optional, but could be helpful in our investigation): *
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This form was created inside of Licking Regional Educational Service.