Anonymous Bullying Report Form (Pequot Lakes Middle School)
Bullying is a serious issue and will not be tolerated at Pequot Lakes Middle School. Use this form to report bullying that occurred on school property, on the bus, was a part of a school event, on social media or through text message during the school day.

Bullying reports can be completed via this form, or through the use of an Incident Documentation Form (which can be found in the ML Office.)

Student Name
Your answer
Today
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I am a:
Phone Number (Optional)
Your answer
Email Address (Optional)
Your answer
Student who was harmed (please provide grade):
Your answer
Student(s) who did harm (please include grade):
Your answer
Date of Incident
MM
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DD
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YYYY
Did you witness the incident?
Did any other students witness the incident?
Your answer
Time of Incident
Time
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Location of Incident:
Your answer
Nature of Bullying Being Reported:
Did the Bullying Include Mean Comments About You Or Other Students?
Please provide the office with any other details about the incident that you feel are important.
Your answer
Submit
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