Bullying Incident Report Form
Use this form to report incidents of bullying that you might witness. Your report may be kept anonymous if you prefer. All reports go directly to the Principal and Assistant Principal to be investigated.
Victim of suspected bullying
Type the name(s) of the person/people being bullied here.
Your answer
Person/people doing the bullying
Your answer
Where is the suspected bullying taking place?
Check all that apply
How long has the bullying been going on?
Your answer
Does the bullying involve the use of cell phones or social media (CyberBullying)
Check one of the boxes
Please provide us with a description of the type of bullying
Your answer
Contact Information (Not Required)
If you would like us to contact you with information we discover, you may provide your information here
Type your name in the space provided if you want to be contacted. (Optional)
Your answer
Phone number
Type your phone number in the space provided if you would like to be called. (Optional)
Your answer
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