RCSD Bullying Incident Report
If you have been the target of bullying or have witnessed the bullying of a Rankin County School District student, you may complete the form below. Information submitted will be forwarded to the building principal where the incident occurred during normal school operating hours. Reports of bullying will be investigated and disciplinary action will be taken if warranted.

You have the right to complete this form anonymously; however, it will be easier for the school to investigate this matter if as much information as possible is provided.  By completing the form below, you are certifying that you are making a good faith & as truthful as you know report of bullying behavior.  A complainant that knowingly falsely accuses someone could be subject to disciplinary and possible other legal action.  


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Email *
What is the difference between normal conflict & bullying behavior?
Today's Date *
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Your Name
Contact Phone Number
School Where Incident Occurred *
Check the box of the person reporting the bullying (the person who is filling this form out) *
Required
Date of bullying incident *
MM
/
DD
/
YYYY
Name of person(s) subjected to alleged bullying *
Age of the target of alleged bullying   *
Grade level of person subjected to alleged bullying *
Person(s) alleged to have committed the bullying behavior *
Age of person(s) alleged to have committed  bullying *
Grade level of person(s) alleged to have committed bullying *
Where did the incident(s) of alleged bullying occur?  Choose all that apply:
Column 1
On school property
On a school bus
At a school sponsored event/activity
online via technology
on the way to & from school
Other
Summarize the alleged incident(s) or occurrence(s) of bullying as accurately as possible. *
Did the alleged bullying behavior described above meet any of the following criteria? *
Required
Names of Witnesses *
Is this the first incident you are aware of? *
Have you reported this to anyone else? *
Required
If you said yes above, please explain who you reported to
I certify that this report is being made in good faith and the details I have provided are true and accurate as far as my understanding. *
A copy of your responses will be emailed to the address you provided.
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