Bullying Behavior Report for LMHS (Public Use)
This form serves as official documentation of a report of bullying behavior at Lakeview Middle-High School and will automatically be sent to LMHS Principals for review and follow up. If you have not heard from the office within 2 school days after filing this report, please contact Mrs. Laurie Snyder at
, Mr. David Blakley at
or call 724-376-7911.
Your name and best contact info
(Those reporting are encouraged to include their name and contact information, but may choose to write simply: student, parent, etc. Please note that all reports will be kept confidential and the names of those reporting will not be shared. However, the ability to contact the reporter will help ensure that the bullying behaviors do not continue, as administration will be able to follow up with the person reporting).
Name(s) and Grade Level(s) of person(s) exhibiting Bullying Behaviors
Please provide as many details as you can.
How did you become aware of this incident?
Check all that apply
Directly observed/experienced the incident
Was directly told about the incident from someone involved
Was told about the incident from someone who was not involved
Date and Time of Incident
(Please give a general time frame if exact date is not known. Ex. last week on the a.m. bus ride, over the summer, 2-3 days ago, etc.).
Name(s) and Grade Levels of Targeted Student(s) (First & Last)
Description of Reported Incident
Please be specific and factual about the incident. Include any witnesses, the location(s) of incidents, etc.
OFFICE USE ONLY
A copy of your responses will be emailed to the address you provided.
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