Scotland County Schools Bullying Report
School of Health-Science
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Have you reported this event to anyone in authority? *
This could include a teacher, principal, or staff member at a school.
Name of person allegedly being bullied. *
Please put first and last name if known
Alleged location: *
Where did this incident take place?
Date of alleged incident *
Name of alleged bully.
(if known)
The alleged bully is a: *
Your name.
This question is optional.
I am a: *
What occurred? *
Please check all that apply.
Description of event *
Please be specific and include location, date, and time
Did you witness the event? *
If you did not witness the event, how were you made aware of what happened?
Please list other students/staff who witnessed the event.
Additional comments:
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