Franklin Central School's Suspected Bullying/Harrassment Reporting Online Form
The Franklin School District is committed to providing a learning environment that promotes respect, dignity and equality. The Board of Education recognizes that harassment, discrimination, hazing, and bullying hinder student learning and achievement. This form is intended to inform school personnel of alleged incidents of harassment. If you are reporting an incident please fill-in the required information below, and click submit. The form will forwarded to the Dignity for All Students Act Coordinator. Thank you for supporting Franklin Central School in providing a safe and supportive learning environment.
Name of alleged agressor(s) or bully(s):
Name of witness(es):
Who else saw the suspected bullying incident occur?
Where did the incident occur?
On school property
At a school sponsored event
facebook or other social media
text phone message
If you answered classroom, please indicate what teacher's classroom the suspected incident occured
What behavior describes what happened
Cyber-bullying (online social media)
Physical bullying (pushing, hitting, punching, etc)
Verbal threats and intimidation
Public humiliation or ridicule
Has this bullying ocurred longer than this incident? Please describe
Did any adults witness this suspected bullying incident? If yes, who
Was this incident reported to an adult? If so who
What date and time did the suspected incident occur?
Please describe the incident below in as much detail as you can:
Name of the person completing this form:
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