Student Bullying Report Form
When someone says or does something intentionally hurtful and they keep doing it even when you tell them to stop or show them that you’re upset, that’s BULLYING.


Please fill out the form for any incident that is bullying.

Person Reporting the Bullying (First & Last Name) *
If you want your response to be anonymous, please write "anonymous."
Your answer
When did the bullying happen? *
MM
/
DD
/
YYYY
Approximately what time? *
Time
:
Who was bullied? (First & Last name if possible) *
If unsure of the name, describe the student to the best of your ability.
Your answer
Who is the principal of the student that is being bullied
Who was doing the bullying? (First & Last name if possible) *
If unsure of the name, describe the student to the best of your ability.
Your answer
What type of bullying was taking place? *
Check all boxes that apply
Required
Where did the bullying take place? *
Check all that apply
Required
How many times has this happened? *
Is there any other information that you would like to share?
Your answer
Submit
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This form was created inside of Devils Lake Public Schools.