Bully Report Form
This form can be used to fill out if you or someone you know is being bullied and you do not have the opportunity to report the bullying in person to the school principal, counselor, or designated teacher. Forms can be dropped off to any staff member, the school office, or dropped off in the building's reporting box.

Bullying is an aggressive behavior among school aged children that involves a real or perceived power imbalance. The behavior is repeated and unwanted.

Reporter's Name (if you wish to share)
Your answer
Reporter's Grade
Who is the alleged target? (Name and Grade)
Your answer
Who is the alleged bully? (Name and Grade)
Your answer
Name and grade of witnesses or bystanders?
Your answer
Where did the incident occur?
Was the alleged bullying physical, verbal, relational, or cyber.
Please describe the incident.
Your answer
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