Report a Bully Form
Please provide the most information so that the School District Administrators can follow up to resolve this reported issue.
Who are you? *
Where did this occur? *
Location of incident? *
Date of incident? *
MM
/
DD
/
YYYY
Approximate time of incident: *
Time
:
Approximate number of times this has occurred? *
Have you reported this to an adult at school? *
Have you reported this to an adult outside of school? *
Who was bullying, harassing, intimidating or causing harm? (Name and grade) *
Your answer
Describe what happened. (Please provide as much detail as possible) *
Your answer
If you are not a student at this campus and would like someone to contact you, please leave your phone number.
Your answer
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