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IHS Bullying Report
Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.
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* Indicates required question
Date of Incident
*
MM
/
DD
/
YYYY
Date of Report
*
MM
/
DD
/
YYYY
Who was the person(s) engaged in bullying?
Your answer
Grade of person(s) who engaged in bullying?
Your answer
Who was being bullied?
Your answer
Grade of person who was being bullied?
Your answer
What type of bullying?
Physical
Emotional/Social
Damage to Property
Online
Where did the incident take place?
After School
Bus
Cell Phone
Classroom
Hallway
Gym
Internet
Locker Room
Lunch Room
Playground
Restroom
School Sponsored Event
Other:
Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)
Your answer
Describe what happened with as many details as possible.
Your answer
Person reporting the incident:(OPTIONAL). Please use your full name.
Your answer
May we contact you for more information on this incident?
Yes
No
Clear selection
Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.
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