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Glacier Gateway Bullying Reporting Form 2025-26
Incident Reporting, Notification, and Tracking
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* Indicates required question
Date
Your answer
Person making the report
*
Your answer
Student being bullied
*
Your answer
Gender
*
Choose
Male
Female
Homeroom Teacher
*
Choose
K-Jennifer Miller
K-Alyssa Drew
K-Jennifer Thurston
1-Jodi Jensen
1-Mary Ellen Getts
1-Cami Harwood
1-Sally Weaver
2-Laura Emerson
2-Patricia Hall
2-Emily Harries
2-Allie Schulz
3-Emily Erler
3-Emily Hagreen
3-Suzann Jensen
3-Troy Miller
4-Mary Beth Chappelow
4-Jane Dews
4-Carrie Gnauck
Kylie Rocker
5-Mandi Douglas
5-Anna Pickard
5-Trista Schaeffer
Month of incident
*
Choose
January
February
March
April
May
June
July
August
September
October
November
December
Day of incident
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Multiple days
Incident Time
*
Before School
During class
Morning Recess
Lunch
Lunch Recess
During Specials
Afternoon Recess
After School Bus Line
After school/ bus
Multiple locations
Required
Incident Location
*
Choose
Classroom
Hallway
Playground
Cafeteria
Bathroom
Bus
PE
Library
Technology
Music
After school line up
Multiple locations
Student doing the Bullying
*
Your answer
Gender
*
Choose
Male
Female
Homeroom Teacher
*
Choose
K-Alyssa Drew
K-Jennifer Miller
K-Jennifer Thurston
1-Mary Ellen Getts
1-Jodi Jensen
1-Cami Harwood
1-Sally Weaver
2-Laura Emerson
2-Patricia Hall
2-Emily Harries
2-Allie Schulz
3-Emily Erler
3-Emily Hagreen
3-Suzann Jensen
3-Troy Miller
4-Mary Beth Chappelow
4-Jane Dews
4-Carrie Gnauck
Kylie Rocker
5-Mandi Douglas
5-Anna Pickard
5-Trista Schaeffer
Bystanders or witnesses
Your answer
Incident Type
*
Verbal
Non-verbal
Physical
Relational
Cyberbullying
Required
Describe Incident
*
Your answer
Please report any previous bullying that the student has done, or any other information you think is important
Your answer
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