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Auburn Middle School Bullying Report Form
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* Indicates required question
Name of Complainant/Reporter
(Optional: By law, reports may be anonymous.)
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Status of Reporter
Student
Parent
School employee/coach/advisor, etc.
Other:
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Contact information for reporter (if reporter is a student, contact information for parent/guardian)
Reporter Phone Number
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Reporter Email
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INCIDENT DETAILS
Name(s) of alleged target(s)
Your answer
Name(s) of alleged bully(ies)
Your answer
Relationship between alleged target(s)/bully(ies)
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Time(s) and location(s) of alleged incident(s)
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Name(s) of witness(es)
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Description of incident(s)
*
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BY SUBMITTING THIS FORM, I AGREE THAT THE INFORMATION I HAVE PROVIDED IS ACCURATE AD TRUE TO THE BEST OF MY KNOWLEDGE AND BELIEF.
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