USD 113 Anonymous Bullying Report Form
The staff and administration of USD 113 is dedicated to the prevention of bullying and the kind treatment of all people. Thank you for taking the time to report bullying when you see it. This form does give an opportunity for you to identify your name, but this is NOT required. We only ask for it in case we need to follow up for more information. Please be as complete as possible as you fill out the form.
Date Report is Being Submitted (today's date) *
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Date of the Bullying Event You are Reporting *
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Name(s) of the person or people doing the bullying?
Your answer
Grade of the person or people doing the bullying?
Your answer
School where the bullying person attends.
Name of the person being bullied. *
Your answer
Grade of the person being bullied.
Your answer
What type of bullying are you reporting? *
Where did the bullying happen? *
More details about the location
If you're able to give exact details about the location of the bullying event, do so here.
Your answer
Describe the bullying event. *
Give as much detail as you can about what happened.
Your answer
Optional: Name of Person Reporting the Bullying
Your answer
May we contact you if more information is needed?
If you'd like a copy of this report emailed to you, enter your email here.
Your answer
Submit
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