Kit Carson School
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?
At an after school activity
At the bus stop
In a Text message
In an email
In an instant message
In front of the building
In the bathroom
In the Cafeteria
In the Gym
In the hallway
In the locker room
In the parking lot
On the bus
On the field
Over the phone on on a voicemail
When did it happen?
What time did it happen?
How many times has this situations happened?
This is the first time
One other time
Once a month
Once a week
Once a day
Multiple times a day
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.
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This form was created inside of Kit Carson Union School District.