Bullying Incident Report Form (BOE Form 2655)
If you have been the target of or have witnessed the bullying of a Lincoln County R-III student, complete this form and click submit. Reports of bullying will be investigated and disciplinary action will be taken according to the handbook.
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Your Name (Students have the right to complete this form anonymously. However, it will be easier for the District to investigate this matter if as much information as possible is provided. Submission of a good faith complaint or report of bullying or harassment will not effect the complainant or reporter's future employment, grades, learning, or working environment. A complainant that falsely accuses someone will be subject to disciplinary action.)
Phone Number(s) or other contact information:
You are a:
District school where the bullying took place
Early Childhood Education Center
Claude Brown Elementary
Cuivre Park Elementary
Hawk Point Elementary
Main Street Elementary
William Cappel Elementary
Troy Middle School
Troy South Middle School
Ninth Grade Center
New Horizons High School
Troy Buchanan High School
Dates of alleged bullying
Name of student(s) subjected to bullying
Person(s) alleged to have committed the bullying or harassment
Summarize the incident(s) or occurrence(s) of bullying as accurately as possible.
Names of witnesses
Have you reported this to anyone else?
If so, who did you report this to?
By choosing yes below, I am indicating an electronic signature.
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