Incident Report Form
Please fill out and submit this form to file an incident of alleged bullying or harassment. Upon submission, the form will be directed to the school principal/designee or the appropriate district office.

THIS FORM MAY BE SUBMITTED ANONYMOUSLY.
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Your Name: (Not Required)
What is your relationship to the district? *
Your Email Address:
Phone Number:
Name of Victim: *
Grade of Victim *
Date of Incident: *
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/
DD
/
YYYY
Who was involved? *
What happened? *
When did it start? How long has it been going on? How often has it occurred? *
Where did the incident occur? *
Were there witnesses? *
List any possible witnesses: *
Have you ever told anyone about this problem? *
If so, who did you tell?
Have you previously filed a report with the District? *
Please Explain: *
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