Bullying Incident Report
Please use this form to report bullying incidents of or by DISD students/staff. You can report for yourself or for someone else. Please include as much information as possible, so that the district can fully investigate your report. You are not required to submit your name, but you may do so if desired.
Please enter the name of the person who was bullying another person. *
Your answer
If you know it, please enter the school of the person who was bullying another person.
Your answer
If you know it, please enter the grade level of the person who was bullying another person.
Your answer
Please enter the name of person who was being bullied. *
Your answer
If you know it, please enter the school of the person who was being bullied.
Your answer
If you know it, please enter the grade level of the person who was being bullied.
Your answer
Where did this bullying incident take place? *
Please explain the incident. What happened? Include as many details as possible. *
Your answer
Please enter the date of the incident. *
MM
/
DD
/
YYYY
Please enter the approximate time of the incident. *
Time
:
Did you report this to anyone else? *
If your answer was YES, to whom did you report the incident?
Your answer
Please enter a phone number so that you may be contacted if additional information is needed. *
Your answer
OPTIONAL - Please enter your email address.
Your answer
OPTIONAL - Please enter your name.
Your answer
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