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Bolivar High School Bullying Incident Report
(Bullying Incident Report Form for Use by Parents, Students and Community Members)
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Reporter (Person filing the report)
Bullying frequently involves repeated behavior. If you have witnessed or have knowledge of more than one incident, please provide information on all incidents. Please feel free to use multiple forms.
Name:
*
Your answer
Address:
*
Your answer
Phone Number:
*
Your answer
Email Address:
Your answer
Relationship to the student being bullied:
*
Parent/Guardian
Fellow Student
Community Member
Anonymous (It is more difficult to follow up on anonymous reports)
Other:
Did you witness this incident?
*
Yes
No
If no, provide the specific information as to how you found out about this incident:
Your answer
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