Bullying Incident Report
Please fill out as much detail as possible. You can stay anonymous or you may provide your name.
Date of incident
Time of incident
Roughly what time did the incident occur?
Check all that apply
After school program
School Sponsored Event--athletic event, concert etc
Name of victim(s)
Name of Student(s) bullying
Names of wittnesses/bystanders:
Type of Bullying
Any physical evidence? (notes, texts, calls..)
Describe the incident
Include as much detail as possible
If you'd like to give us your name, we will be in contact with you about this incident. Or you may wish to stay anonymous.
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This form was created inside of Salisbury-Elk Lick School District.