HMS Social Responsibility Report Form (2022-2023)

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Remember, everything on this form is anonymous and confidential. We will help you as best we can! This form is checked during regular school hours (8:00 a.m.-4:00 p.m.) when school is in session. If it is an emergency, please call 911.

Your name:

This question is OPTIONAL.

Your grade: *

Skills

Required

Who is the target of the unkind behavior? *

Who is the person being unkind to someone else/others? *

WHERE is this happening? *

Check ALL that apply.

6th grade classroom

6th grade hallway

6th grade restroom

6th grade pod - outside the pod before/after school

7th grade classroom

7th grade hallway

7th grade restroom

7th grade pod - outside the pod before/after school

8th grade classroom

8th grade hallway

8th grade restroom

8th grade pod - outside the pod before/after school

Cafeteria

Commons restroom

Gym or locker room

Band/Choir/Orchestra room

Exploratory Classroom

Other:

Required

WHEN is this happening? *

For example: "between 4th and 5th period"..."during 7A lunch"..."right by my locker"...etc

WHAT is happening? *

For example: "hurtful words"..."physical bullying"...etc.

Is there any additional information that would be helpful for us to know? *

Submit

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