See Something, Say Something
The purpose of this tool is to inform the district of threats to the school, and any incident or series of incidents of bullying and/or harassment so we can investigate and take appropriate steps.

If you feel unsafe, if your child/student feels that way, or if you are a witness to unkind or hurtful behavior, please fill out this form.

We also urge you to speak directly with the building principals by calling the main office of the school as soon as possible so we may address your concerns.

**Providing your name is necessary so we may follow up with you regarding your concerns. Mr. Coffin and Mrs. Cruikshank are the only two individuals with access to the information you provide in this form.

**We realize it takes courage to come forward with sensitive information, which is why we promise to work diligently and discreetly with you in order to help resolve your concerns.
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Email *
Email where I may be reached: *
Name of person filling out this form: *
Students filling out this form will be contacted in person at school. If you are NOT a student, please provide a phone number where you may be reached.
Grade level of victim: *
Describe the incident(s). Please include when and where the incident happened. *
List the name(s) of the individual(s) accused of bullying and/or harassment. *
Please list the names of other individuals who witnessed what happened:
Today's Date *
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Please deliver any supporting documentation to your building principal (i.e. copies of emails, notes, photos, etc.)
Note of Confidentiality: In order to investigate the complaint, the district will disclose the content of the complaint only to those persons who have a need to know. This form will not be shown to the accused student(s)/staff.
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This form was created inside of Parishville-Hopkinton CSD. Report Abuse