FDR Bullying & Harassment Reporting Form
The Hyde Park Central School District Board of Education condemns and strictly prohibits all forms of discrimination, such as harassment, hazing and bullying on school grounds, school buses and at all school-sponsored activities, programs and events.

This form can be used to report incidents of bullying and/or harassment. As an alternative to completing this form, anyone compelled to report an incident may seek out a trusted adult.

This form is specifically designed for F.D. Roosevelt High School. Information submitted using this form is transmitted to FDR only. To report bullying in a different Hyde Park school, please contact the appropriate principal or designee.

Information from this form is submitted securely to the FDR administration. The identity of anyone completing this form will be kept confidential.

Please identify the bully/bullies in this incident *
Your answer
Please identify the target/targets in this incident *
Your answer
What was the date of this incident? *
MM
/
DD
/
YYYY
The incident occurred *
What was the approximate time (or class period) of this incident? *
Your answer
Location of incident *
Your answer
Type of bullying/harassment *
Required
Please describe the incident in detail. *
Your answer
Frequency of bullying/harassment *
If cyber-bulling, we ask that you print and provide a copy of the information (e.g. print a copy of a Facebook posting) and submit it to the principal's mailbox in the main office (or mail it to the principal). Are you willing to submit a copy?
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