Kit Carson School
Sign in to Google to save your progress. Learn more
Email *
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. *
Who was the person being harmed, bullied, harassed or intimidated? Include first name, last name and grade if known. *
Describe what happened. Give as much information as you can. Let us know if there were any witnesses. *
Who are you? *
What is your name?
If you would like someone to contact you, please add your email or phone number here.
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kit Carson Union School District. Report Abuse