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.)

Email address *
Student Name
Today
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I am a:
Clear selection
Phone Number (Optional)
Email Address (Optional)
Student who was harmed (please provide grade):
Student(s) who did harm (please include grade):
Date of Incident
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Did you witness the incident?
Clear selection
Did any other students witness the incident?
Time of Incident
Time
:
Location of Incident:
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.
Submit
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