Dublin Unified School District Anonymous Bullying Tip Line
This form will viewed only by district and site administration.

Per DUSD Board Policy: No student or group of students shall, through physical, written, verbal, or other means, harass, sexually harass threaten, intimidate, cyberbully, cause bodily injury to, or commit hate violence against any other student or school personnel.

Please complete as much of the following information as accurately as possible.

Select School
If Elementary Level: Type Grade Level & Teacher Name
Your answer
Describe what happened/what is happening. Please be as specific as possible
Your answer
When did it happen?
MM
/
DD
/
YYYY
What time of day did it happen?
Where did it happen?
Have you shared your concerns with someone already/if so, whom?
Did anyone else witness the bullying? If yes, please include details.
Your answer
Were you or others physically hurt? If yes, please explain.
Your answer
Other comments and concerns
Your answer
If you would like to be contacted about this incident, please type your name and contact information below. All contact information is kept confidential and viewed only by district and site administration.
Your answer
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