PGHS Reports Bullying
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What is the name of the student you would like to report? If you do not know the name please describe the student
When did the incident take place
About what time did the incident take place on the date stated above?
Where did the incident take place? (Please be specific!)
Please describe the incident by providing details and information. Please be specific.
Were their witnesses to the incident?
Please provide names or descriptions of the witnesses.
Please describe the frequency with which this type of incident occurs.
Please describe any evidence that exists of the bullying.
Letters, photos, texts, etc. If you can provide this please leave it with a counselor or a principal.
I am a
This questions allows us to better serve the students, parents, or community.
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This form was created inside of Randolph County School System.