See Something, Say Something: Bullying & Harassment Online Report
This is an anonymous reporting tool for the community of Millburn to use when they need to report bullying and/or harassment.  
Link to Millburn's Final Policy on Bullying

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District 24 Millburn Middle School
Name of person (being bullied). *
Grade Level *
Date *
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DD
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YYYY
Your Role
Clear selection
Who is doing the bullying/harassing? *
What has happened? (Describe the incident being as specific as possible.) *
Who else witnessed the incident?
How long has this been going on?
Have you tried anything to stop the bullying? *
Required
What do you want to happen next? *
Name of person reporting. You can leave this blank if you want to remain anonymous. If you leave your name, Mrs. Lastacy and Mr. Jorgenson are able to follow-up with you.
Bullying includes cyber-bullying (bullying through the use of technology or any electronic communication) and means any severe or pervasive physical or verbal act or conduct, including communications made in writing or electronically, directed toward a student or students that has or can be reasonably predicted to have the effect of one or more of the following: 1. Placing the student or students in reasonable fear of harm to the student’s or students’ person or property; 2. Causing a substantially detrimental effect on the student’s or students’ physical or mental health; 3. Substantially interfering with the student’s or students’ academic performance; or 4. Substantially interfering with the student’s or students’ ability to participate in or benefit from the services, activities, or privileges provided by a school. Examples of prohibited conduct include name-calling, using derogatory slurs, stalking, sexual violence, causing psychological harm, threatening or causing physical harm, threatened or actual destruction of property, or wearing or possessing items depicting or implying hatred or prejudice of one of the characteristics stated above. *
Required
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