Franklin Academy Report Harassment Form

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This form is for anonymous reporting of harassment incidents that occur by any Franklin Academy student during school hours or at any school sponsored activity. In most cases, bullying or harassment of students should first be reported directly to an administrator at the school. If you are not comfortable reporting directly to the school, please answer a few short questions:

What is the exact location where the incident occurred? *

(for example: homeroom, the front porch, the gym locker room)

Name of person (s) being bullied or harassed: *

Grade level of person being bullied or harassed? *

Name of the person (s) who was bullying or harassing

Please provide a brief description of the incident *

(be sure to include as many details and specific information as possible)

Did anyone else see this happen? If so, who?

Do you know if anyone else reported this incident to the school? *

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