JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bullying Report Form
Reporting bullying or harassing behavior is the first step toward making our schools a safe place for everyone. Please report bullying if you are experiencing it, or witness it in school, on the bus, at school events, or online.
Use the following form to report bullying. Fill it out online and it will be submitted directly to the administration staff of the school. Reports are held in the strictest of confidence.
Whether you are a witness or target in this case, we want to thank you for helping us maintain a positive and safe school environment for all of our students. (All names provided are kept confidential.)
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Your Name (This is not required, but would be appreciated. This report will be kept confidential and your identity will remain anonymous):
Your answer
When did the bullying occur?
*
(Please tell us the date it happened):
MM
/
DD
/
YYYY
Where did this happen?
*
(For example, the bus stop, the cafeteria, on the internet, etc.):
Your answer
Name of Bully(ies):
*
Your answer
Name of Target(s):
*
Your answer
Describe what happened as clearly as possible with as many details as you can remember:
*
Your answer
Were there any witnesses?
*
(If yes, please list their names, if you know it, or a description):
Your answer
Did you report this to anyone?
*
(If yes, please tell us who. For example, a policeman, parent, teacher, etc):
Your answer
Please choose the grade level:
*
Choose
9th grade
10th grade
11th grade
12th grade
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. -
Terms of Service
-
Privacy Policy
Does this form look suspicious?
Report
Forms