KMS Reporting Form
This form is a way for you to report bullying and harassment. Please know that you can also report directly to the office or to a staff member who you feel comfortable reporting to.

Instructions: Complete by responding to the questions that you feel comfortable answering and are able to accurately answer. Please note that the District prohibits retaliation against anyone who submits a report. If you do not include your name in this report the District's ability to investigate an anonymous complaint and subsequent actions may be limited.
Describe what happened/what is happening.
When did it happen?
MM
/
DD
/
YYYY
Time
:
Where did it happen?
Who was involved?
Were there other witnesses?
If so, please list(optional)
Were you or others hurt or frightened?
Please explain.
Have you or the victim missed any school or made any changes to daily routine as a result of the incident(s)?
Please explain.
Who have you told about this?
Person making the report:
Optional
Your grade and age:
Optional
If you are not a student, how can we contact you?
Phone, E-Mail, Other:
Submit
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