GPS Bullying/Incident Reporting Form

Directions: If you are a student, the parent/guardian of a student, a volunteer or visitor, and wish to report an incident of alleged aggression, bullying, harassment, or a bias incident, you may contact the child's school directly or you may complete this form.  All school employees are required to report alleged violations. 

Anonymous reports will be investigated, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report. Please note that this submission will not be seen after school hours. If this incident requires a more immediate response where imminent danger may be a concern, please contact the appropriate legal authorities or call 911.

For more information, please refer to our district Bullying Prevention and Intervention Policy (File: JIFCB).

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Date of incident, if known
Description of the incident *
Please select the most appropriate description of the incident (check all that apply)
Required
Description of words or actions
If any of the words or actions of the alleged aggressor were based on the following, check all that apply
Description of Incident(s) *
Description of Incident(s) including names of people involved, what occurred and what each person did and said, including specific words used.  
Name of Alleged Aggressor (s)
Grade of Alleged Aggressor(s)
Location of Incident(s) *
Required
Name of Alleged Target (s)
Grade of Alleged Target *
Witnesses
Witnesses (List people who saw the incident or have information about it). Please provide name and role (student, parent/guardian, staff or community member)
Name of Reporter (Optional)
Role
Clear selection
Other information
Any other information that you feel would be helpful to consider when investigating this report.  If you wish to be contacted please provide best means of communication below.
Submit
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