Bullying Incident Report
If this is an emergency that needs immediate attention please call 911 or contact your health care provider immediately as this site is only monitored during school hours.
Please be advised, if a report is made anonymously it will limit our investigation process and we will be unable to follow up with the person making the report.
Students found responsible for deliberately making false reports may be subject to a full range of disciplinary consequences as publicized in student handbooks.
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Name of Reporter/Person Filing the Report:
Optional: If a report is made anonymously it will limit our investigation process and we will be unable to follow up with the person making the report.
Email of person reporting:
Are you the target of the behavior?
Are you a:
SAS Elementary School
SAS Middle School
SAS High School
Information about the Incident
First & Last Name of target (of behavior)
First & Last Name of Aggressor (person who engaged in the behavior)
Date of Incident:
Time of Incident:
Location of Incident:
List people who saw the incident or have information about it.
Detail of Events:
Describe the detail of the incident (including names of people involved, what occurred, and what each person did and said, including specific words used).
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This form was created inside of Syracuse Academy of Science Charter School.