Delphi Community School Corporation Bullying Report Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Delphi Community School Corporation maintains a firm policy prohibiting all forms of bullying. Everyone is to be treated with respect and dignity. Bullying by any student, teacher, administrator, or other school personnel which creates an intimidating environment will not be tolerated under any circumstances.

Please use this form to report issues relating to bullying, cyber-bullying, racism, or other forms of harassment.

This information is confidential and will be shared with others only for investigation and follow-up purposes.

Please understand that all these questions are optional. However, without providing necessary information, it may be difficult to pursue this report.

Your Name: (optional)

I am a: *

Student

Parent/Guardian/Family Member

Volunteer/Staff Member

Other:

Required

Name of person doing the bullying: *

Describe what happened:

Include information on the bully, the victim, any witnesses/bystanders; the more detail provided the better.

Location of the event:

Date/Time of the event:

What sort of help would you like with this issue?

Have you told anyone else about this incident? Who?

Additional Information:

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Delphi Community School Corporation. Report Abuse

Forms