CJHS Anonymous Bullying Form
This form is anonymous and confidential and should only be used when you are feeling a real concern for the physical, social, and emotional well-being of yourself or a fellow student. This form is not for emergencies. If you feel like you or someone that you know is in need of emergency assistance please immediately report to a trusted adult or call 911. Upon submission of this form a request will be sent to Mrs. Janzow or Mrs. Blum-Zipprich anonymously.
Please type below the name of the student that you are concerned about.
Your answer
Where did the incident that you are reporting happen?
Your answer
Please describe the problem or incident that you witnessed/heard that you are concerned about.
Your answer
What is the approximate date and time that this incident occurred?
Your answer
If you would like to leave your name please do so below.
This is optional and not required to submit the form.
Your answer
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