Anonymous Bullying Reporting Form 2021-22
If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge.
**Please Note: Students are prohibited from deliberately making false reports of bullying, harassment, threats, or intimidation. Those who make false reports will be subject to disciplinary action according to the Code of Conduct and Ohio Revised Code.**
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* Required
What date did the alleged bullying incident occur?
*
Your answer
Who do you believe was bullied?
Your answer
Who do you believe was the bully (or bullies)?
Your answer
Where did the incident happen? Check all that apply.
On school property
At a school sponsored activity
On the school bus
At a bus stop
On the way to/from school, but not on the bus
Online
Other:
Clear selection
Put a check next to the statement(s) that best describe(s) what happened. Check all that apply.
Teasing
Threatening
Physical Violence
Name Calling
Social Exclusion
Intimidation
Theft
Sexual Harassment
Cyber Bullying
Stalking
Public Humiliation
Other:
Clear selection
Please describe what happened in as much detail as possible.
Your answer
Do you know any of the witnesses involved? If so, please provide as much detail as possible about these people.
Your answer
Is this report based on your honest belief that the student listed above as the victim has been bullied/cyberbullied and, to the best of your knowledge, is the information submitted a true and accurate representation of events?
*
Your answer
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