Broken Bow Schools Bullying or Harassment Report Form
Complete this form if you have credible information regarding a bullying or harassment incident. You may put your name on the form or submit it anonymously.
**Note: We cannot take disciplinary action solely on the basis of an anonymous complaint.
This report will be followed up in a timely manner.
**If you fear the student is in immediate danger, please contact the appropriate source (ie- call 911, contact the police, Student Resource Officer, or Principal of the School).
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Email *
School for which this incident has taken place. *
Your Name (If you wish to provide it.) *
Today's Date: *
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Alleged Victim's First and Last Name: *
Alleged Bully's First and Last Name: *
Where did the incident occur? Be specific (ie: classroom, hallway, cafeteria, playground, bus, etc.) *
When did the incident occur? *
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What time did the incident occur? *
Time
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What happened? Describe in detail. *
Were there any witnesses? *
Required
Provide the names and contact information of witnesses (if applicable).
List any evidence of bullying or harassment. *
Have you been bullied or harassed or witnessed bullying or harassment by this person before? *
Required
If so, how many times? *
Was a report filed for the previous time (s)? *
Required
When was a report(s) filed? (If applicable.)
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