Report a Bullying, Cyberbullying, Abuse, Sexual Harassment, or Dating Violence Incident
While the district already has many programs to help students deal with challenges such as bullying behaviors, stress, peer pressure, abuse, and family problems, Report a Bullying, Sexual Harassment, or Dating Violence Incident helps break the code of silence often experienced by students because it allows them to report concerns to administrators anonymously.

IMPORTANT NOTE: This is not a crisis line. In cases of emergency, please call 911!


Please complete this form to the best of your knowledge so we can assist you.

Confidentiality:  To conduct this investigation in a confidential manner, the school will disclose the contents of your complaint only to those persons who have a need to know about your complaint.  In submitting the complaint, you authorize the school to disclose, as needed, the information you have provided and may in the future provide regarding your complaint.  Your complaint form will not be shown to the accused person.

Sign in to Google to save your progress. Learn more
Date of Incident *
MM
/
DD
/
YYYY
Time of Incident
Time
:
Who was the person(s) engaged in the incident?
Possible Witnesses:
Who was being bullied, sexual harassed, or dating violence?
Grade of person who was being bullied, sexual harassed, or dating violence.
What type was the bullying? *
Required
Which campus?
Where did the incident take place? *
Required
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.
Is this the first incident? *
If no, how many times has it happened before? Include previous incidents or threats.
Person reporting the incident: (THIS IS OPTIONAL).  If you want to give your name, please use full name.
May we contact you for more information on this incident? *
If yes, please provide contact information
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Groesbeck ISD. Report Abuse