Please complete this form to the best of your knowledge so we can assist you. This information will be kept confidential with your campus counselor.
Please Fill Out The Bullying Incident Form Below
Date of Report:
Date of Incident:
Who was the person(s) engaged in bullying?
Grade of person(s) who engaged in bullying by campus?
Who was being bullied?
Grade of person who was being bullied by campus?
What type of bullying?
Damage to Property
Where did the incident take place?
After School Program
School Sponsored Event
Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc.)
Describe what happened with as many details as possible.
If you want to provide more information please provide your contact information.
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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