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Anonymous Bullying Reporting Form
This online bullying or threatening behavior report was created so that people would have a safe way to report bullying and safety concerns.
When a person really needs help, we hope you will step up and send in a report.
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After you submit the form, this form/report sends an email to a school administrator with all of the details from your bully report. If there is an immediate concern and danger, please call 911.
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* Indicates required question
Who are you?
*
Student
Parent
Teacher
Staff Member
Administrator
Board Member
Volunteer
Other:
Required
Please choose the location where the incident happened.
*
Hallway
Classroom
Gym
Lunchroom
Bathroom
Parking Lot
Other:
Required
Please provide us with the TIME and DATE that the incident happened.
*
Your answer
How many times has this situation happened?
*
This is the first time
One other time
Once per month
Once per week
Every day
Other:
Required
Have you reported this incident to an adult at the school?
*
Yes
No
Who was bullying, harassing, intimidating, or causing harm? (Please include first name, last name, and grade, if possible.)
*
Your answer
Describe what happened. Give as much information as you can. Let us know if there were any witnesses.
*
Your answer
If you would like someone to contact you, please add your phone number or email address. (OPTIONAL)
Your answer
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This form was created inside of Pioneer Regional School Corporation.
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