Bully Report Form
Use this form to report any bullying incident related to Wind Gap Middle School
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Your Name: (Not required, but helps to investigate.)
Your Grade: *
Name of Bully: *
Name of Victim(s): *
Bystanders: (The explanation of the bystander is a person who is near and observes the bullying.  The bystander can either support the victim by stepping in or by reporting the bully.)
Date of Incident: *
MM
/
DD
/
YYYY
Where did the incident occur: *
Describe what happened: *
Is this the first time you / this person has been bullied? *
What was your response to experiencing this or observing this incident? (not required to answer this question)
Additional Comments:
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