Report Bullying Incident
Use this form to report a bullying incident at Harrold ISD
Name (Leave this answer blank if you want this report to remain anonymous):
Your answer
Email Address (Leave this answer blank if you want this report to remain anonymous):
Your answer
Date of Incident (Note:If the exact date is unknown, give a date as close to the actual date as you can know) *
MM
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DD
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YYYY
Where did the incident occur? *
Describe details about where the incident occurred (classroom teacher, bus number, area of playground, gym, etc.): *
Your answer
Type of Bullying *
Specific details about type of bullying that are important to understand: *
Your answer
List any witnesses to the incident in this report:
Your answer
Has this bullying incident been reported to any school personnel? *
If "Yes" was answered to the previous question, list all school personnel to whom this incident was reported? If you marked "No" to the previous question, write "None" below. *
Your answer
Date(s) reported to school personnel. If the incident was not reported, write "None" below *
Your answer
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