Kit Carson School
Bullying Report
The contents of this report are strictly confidential. Only the district ADMIN will have access to the records once the forms have been submitted.

What Can I Report
• Safety threats, bullying, harassment or intimidation at school
• Safety threats, bullying, harassment or intimidation outside of school
• Cyberbullying; Facebook, Instagram, YouTube, etc.
• Fights, drugs, alcohol or weapons at school
• Friends who talk about hurting themselves

Where did the incident occur? *
When did it happen? *
MM
/
DD
/
YYYY
What time did it happen? *
Required
How many times has this situations happened? *
Have you reported this to an adult? *
Who was bullying, harassing, intimidating or causing harm? Include first name, last name and grade if known. *
Your answer
Who was the person being harmed, bullied, harassed or intimidated? Include first name, last name and grade if known. *
Your answer
Describe what happened. Give as much information as you can. Let us know if there were any witnesses. *
Your answer
Who are you? *
What is your name?
Your answer
If you would like someone to contact you, please add your email or phone number here.
Your answer
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