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.
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* 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?
*
Your answer
What is your phone number? (Optional)
Your answer
What is your e-mail address? (Optional)
Your answer
Are you a:
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Bystander/student
Parent/Guardian
Other:
The Bullying Incident
List the name(s) of the alleged offenders.
*
Your answer
Please describe the bullying incident. Try to include as many details as possible
*
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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