Student Bullying Report
Please use this to report incidents of bullying to the school counselor and administration.
School Name
Today's Date
MM
/
DD
/
YYYY
Date Incident Occurred
MM
/
DD
/
YYYY
Person Reporting This Incident
Required
Your Name
Your answer
Who do you think was bullied? What grade?
Your answer
Who do you think was bullying? What grade?
Your answer
Were there any witnesses?
Name(s) of witnesses
Your answer
Type of Bullying (check all that apply)
Where did this happen? (check all that apply)
Is this the first time this has occurred?
Have you filed a Student Bullying Report before?
Who has been told about the incident or saw it happen?
Is there anything else you want us to know? Please describe below. Thank you for making this report.
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Chattooga County School District. Report Abuse - Terms of Service - Additional Terms