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.
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.
Who are you?
Please choose the location where the incident happened.
Please provide us with the TIME and DATE that the incident happened.
How many times has this situation happened?
This is the first time
One other time
Once per month
Once per week
Have you reported this incident to an adult at the school?
Who was bullying, harassing, intimidating, or causing harm? (Please include first name, last name, and grade, if possible.)
Describe what happened. Give as much information as you can. Let us know if there were any witnesses.
If you would like someone to contact you, please add your phone number or email address. (OPTIONAL)
Never submit passwords through Google Forms.
This form was created inside of Pioneer Regional School Corporation.
Terms of Service