Anonymous Reporting



Anonymous Reporting Form is NOT an emergency hotline. If you are reporting an emergency that demands immediate response for safety reasons, please call 911.

This is a anonymous reporting form and all information is cofidential and is only shared with the appropriate staff members.

 If you feel yourself, another student or staff member may need help for any safety reason including bullying, suicide, sexual harrassment, sexual assault, child abuse, hate crime, substance abuse or any other reason that causes someone to not be safe please fill out this form. 


  “Bullying” means the intentional harassment, intimidation, humiliation, ridicule, defamation, or threat or incitement of violence by a student against another student or public school employee by a written, verbal, electronic, or physical act that may address an attribute of the other student, public school employee, or person with whom the other student or public school employee is associated and that causes or creates actual or reasonably foreseeable: 
-Physical harm to a public school employee or student or damage to the public school employee's or student's property; 
-Substantial interference with a student's education or with a public school employee's role in education;
-A hostile educational environment for one (1) or more students or public school employees due to the severity, persistence, or pervasiveness of the act; or 
-Substantial disruption of the orderly operation of the school or educational environment

For more information on board policies regarding the above please visit our website at www.modoc.k12.ca.us
Board Policies
Bullying BP 5131.2
Sexual Harrassment BP 5145.7
Hate-Movitated Behavior BP 5145.9


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Safety Concern *
Description of Incident or Concern *
Name of Victim *
Victim's School *
Name of Alleged Bully or Abuser *
Witnesses
Your contact information if we may contact you. This is not a requirement in order to submit this form. Please remember we keep all information confidential, including your information.
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