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 *
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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