Terra Nova High School Bullying Report Form
Jefferson Union High School District promotes a secure and positive school climate free from any type of bullying behavior. Anyone who witnesses bullying is asked to report the incident to the school administration immediately.

Falsely accusing one another of bullying is prohibited. Disciplinary action will be taken.

When did it happen? *
MM
/
DD
/
YYYY
Where did the incident occur? *
Who was bullying or causing harm? *
Include first name and last name, if known
Your answer
Who was being bullied? *
Include first name and last name, if known
Your answer
Were there any witnesses? *
Include first name and last name, if known
Your answer
Description of Incident *
Provide as much detail as possible
Your answer
What is your name? (optional)
Anonymous reports are accepted however they must provide sufficient evidence to justify the commencement of an investigation. Formal disciplinary action may not be based solely on an anonymous complaint.
Your answer
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