Bullying Complaint Report Form
DISCLAIMER - Information from this form will be treated confidentially. We will only share this information with appropriate school personnel and law enforcement (if applicable).
Bullying is harmful behavior that is repeated, intentional, and involves an imbalance of power.
Victim Information
Please enter information about the victim below. Please be as specific as possible.
Victim's School
Victim's Name
Person Reporting Incident (Optional)
Phone Number of Person Reporting Incident (Optional)
(xxx)xxx-xxxx
Email Address of Person Reporting Incident (Optional)
Accused Information
Please enter information about the accused bully below. Please be as specific as possible.
Accused Bully Name OR Description
Location of Incident
Date of Incident
MM
/
DD
/
YYYY
Time of Incident
Time
:
Description of Incident
Describe what happened in as much detail as possible.
Submit
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This form was created inside of Coeur d' Alene School District. Report Abuse