Clarksdale Municipal School District
Bullying & Anonymous Safety Alert Form
The Clarksdale Municipal School District is committed to ensuring faculty, staff, and students are safe. This anonymous bullying and safety alert form is for reporting sensitive information to school personnel. This may include violence towards or from a student, employee or teacher, drug use, sexual harassment, bullying, treats, weapons, gang activity, or other inappropriate behavior.

All information is anonymous. Please provide accurate information to the best of your knowledge.

Date and time of incident being reported: *
Your answer
Description of the incident: *
Your answer
Are you a student, parent, teacher, etc. *
Your answer
Name of person(s) endangering student/employee safety or exhibiting misconduct or inappropriate behavior: *
Your answer
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