Rogers Online Bully Report Form
IF YOU ARE IN IMMEDIATE DANGER, CALL 911.

Rogers Middle School is committed to providing a safe, comfortable learning environment for all students. Bullying incidents can be reported directly to a trusted staff member at Rogers. This online form may also by used by Rogers students to report being bullied or by someone witnessing a student being bullied.

Once submitted, the investigation process will begin within five (5) working days. Keep in mind, this process can only be as thorough as the information provided.

Date of incident: *
MM
/
DD
/
YYYY
Location of incident: *
Your answer
Name (optional)
Your answer
Phone (optional)
Your answer
Bullying Incident: Name(s) of alleged offenders
Your answer
Describe the bullying incident. Try to include as many details as possible *
Your answer
Check all that apply *
Required
Indicate if you think the incident was motivated by any of the following
FINAL SUBMISSION
By completing this form, you are verifying that your statements are true and accurate to the best of your knowledge.
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