Bullying Report
Please complete the survey, responding only to the questions that you feel
comfortable answering and are able to accurately answer. Please note
that the district’s ability to investigate an anonymous complaint may be limited, and
the District prohibits retaliation against anyone who files a bullying report.
What date did the incident occur?
MM
/
DD
/
YYYY
When did it happen?
Required
Where did it happen?
Required
Who was committing the bullying (if you don’t know the bully’s name(s) describe him/her?
Your answer
Who was the victim of the bullying (if you don’t know his/her name, describe him/her)?
Your answer
Did anyone else witness the bullying (if yes, please list)?
Your answer
Were you or others physically hurt (please explain)?
Your answer
Was there damage to anyone’s personal property?
Your answer
Have you or the victim missed any school or made any changes to your daily routine as a result of the incident(s)?
Have you told anyone about the bullying?
Required
Have you previously filed a bullying report (this information is used to determine if retaliation is occurring)?
Submit
Never submit passwords through Google Forms.
This form was created inside of McMullen County ISD. Report Abuse - Terms of Service - Additional Terms