Anonymous Bullying Incident Report
The District encourages the reporting of bullying incidents to school administrators whenever possible. In cases where confidentiality is a concern, an anonymous incident report may be filled out below.
Date of Report *
MM
/
DD
/
YYYY
Name(s) of alleged target(s) of bullying *
Your answer
Name(s) of alleged aggressor(s) *
Your answer
Name(s) of witness(es) *
Your answer
When did the incident(s) occur? *
MM
/
DD
/
YYYY
Time
:
Where did the incident(s) occur? *
Your answer
School Name *
Your answer
Please check the box or boxes next to the statement(s) that best describe what happened (choose all that apply) *
Required
Give a brief description of the incident(s) and/or concerns. *
Your answer
Did a physical injury result? *
Please check one of the following
Do you know of other incidents of bullying directed at this student? *
Name of person reporting incident(s)
You may report anonymously
Your answer
Relationship to Student
Optional
Your answer
Email Address
Optional
Your answer
The District is committed to investigating all reported incidents of bullying to ensure that schools are safe and welcoming places for all students to learn. Incidents of bullying can be best investigated when complete information is provided regarding individuals involved, the nature, time, and location of the incident(s) and other pertinent information. While the district's interest is in actively investigating all alleged incidents of bullying, investigations may be compromised when important information is not provided. Thus, please provide all information possible when filling out this form.
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