Bulldogs Against Bullying
Online Bullying Reporting Form • Marshall Middle School is committed to providing a safe, comfortable learning environment for all students. This online form can be used by Marshall Middle School students to report being bullied or by someone witnessing a student being bullied. When filling out the form, provide as much information as possible. This form may be submitted anonymously.
* Required
Where did the incident occur?
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Cafeteria
Classroom
Restroom
Locker Room
Bus
Social Media
Off Campus
Required
Person Reporting the Incident
Please provide your contact information below.
What is your name? (Optional)
Your answer
What is your phone number? (Optional)
Your answer
What is your e-mail address? (Optional)
Your answer
Are you a:
*
Bystander/student
Parent/Guardian
Other:
The Bullying Incident
List the name(s) of the alleged offenders. (Optional)
*
Your answer
Please describe the bullying incident. Try to include as many details as possible (Optional)
Your answer
How would you classify this incident?
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Name Calling
Threat
Cyberbullying
Social Exclusion
Intimidation
Physical Violence
Public Humiliation
Unwanted Touching
Hazing
Other:
Required
Other
If none of the aforementioned classifications fit the incident, please proceed.
Please indicate if you think the incident was motivated by racism, homophobia, transphobia, disability or a form of sexual harassment.
Your answer
By completing this form, you are verifying that your statements are true and accurate to the best of your knowledge.
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