Report Bullying or Policy Violations

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

CSA anti-bullying program is provided for students and parents to anonymously report or notify school officials of situations that may pose a danger to our students or on our campuses.
Our goal is to ensure the safety of each of our students. If you are concerned about someone, please fill out this form and an administrator and/or counselor will inquire about the situation.

False reporting will be taken seriously to the full extent of the law.

DISCLAIMER: This site is not monitored 24/7; please do not use this system for issues requiring immediate assistance. This system will be monitored during school operating hours, during the school year. Any reports submitted outside of these hours, or during holidays, will be responded to during the following normally scheduled school day.

If this is an emergency requiring immediate assistance, please call 911.

Name of who you are reporting (first and last name) *

Who is a: *

teacher

student

Other:

Because of: *

Acceptable Use Violation

Bullying (includes cyberbullying, sexting, dating violence and sexual harassment)

Threatening to hurt him/herself or someone else

Other:

Bullying

Actions determined as bullying must meet the following criteria:
Are sufficiently severe, persistent, or pervasive

A complete description of the incident(s) being reported

Please use this space to add any details that you think will be helpful.(Please be detailed. It helps our investigation.) *

My name is (this is optional)

I am: (this is optional)

A student at CSA

A parent/guardian of a student at CSA

Other:

Clear selection

I have provided adequate detail for administration to investigate the incident *

Yes

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Chaparral Star Academy. Report Abuse

Forms