Bullying Report Form
Have you reported this incident to anyone in authority? *
This would include a teacher, principal, or staff member at school.
Name of the person allegedly being bullied. *
Please put the first name and the last name if known.
Your answer
Location of the alleged incident. *
Required
Date of the alleged incident. *
MM
/
DD
/
YYYY
Name of alleged bully is a: *
Your Name (optional)
First name and last name.
Your answer
I am a *
What happened? *
Please check all that apply.
Required
Description of the event. *
Please be as specific as possible and include location, date, and time of the alleged incidents.
Your answer
Did you witness the event? *
Please list other students/staff who witnessed the event.
Your answer
Additional Comments
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Pamlico County Schools.