KSD Bullying Report Form
Reporting bullying or harassing behavior is the first step toward making our schools a safe place for everyone (this includes cyberbullying). Please report bullying if you are experiencing it, or witness it in school, on the bus, at school events, or online.
Use the following form to report bullying, which includes incidents of cyberbullying. Fill it out online and it will be submitted directly to the administration staff of the appropriate school. Reports are held in the strictest of confidence.
Whether you are a witness or target in this case, we want to thank you for helping us maintain a positive and safe school environment for all of our students. (All names provided are kept confidential.)
Your name. Not required and will remain confidential if given.
Kosciusko Lower Elementary
Kosciusko Middle Elementary
Kosciusko Upper Elementary
Kosciusko Junior High School
Kosciusko High School
When did the bullying and/or cyberbullying occur? (Please tell us the date it happened in mm/dd/yyyy format.)
Where did this happen? (For example, the bus stop, the cafeteria, on the internet, etc.)
Name of Bully(ies)
Name of Target(s)
Describe what happened as clearly as possible with as many details as you can remember.
Were there any witnesses? If yes, please list their names, if you know them, or a description.
Did you report this to anyone? If yes, please tell us who. For example, a policeman, parent, teacher, etc...
Please choose the grade level.
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This form was created inside of Kosciusko School District.