IMS Bullying Report
Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.
Date of Incident *
MM
/
DD
/
YYYY
Date of Report *
MM
/
DD
/
YYYY
Who was the person(s) engaged in bullying?
Grade of person(s) who engaged in bullying?
Who was being bullied?
Grade of person who was being bullied?
What type of bullying?
Where did the incident take place?
Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)
Describe what happened with as many details as possible.
Person reporting the incident:(OPTIONAL). Please use your full name.
May we contact you for more information on this incident?
Clear selection
Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.
Submit
Never submit passwords through Google Forms.
This form was created inside of Itasca ISD. Report Abuse