Report Bullying
Please review the following important notes before reporting an incident:
1) If you're a student, don't forget to talk to your parents or guardians about the incident. If you need immediate help, contact your school's principal.

2) Help your school to help you. Give as much information as possible to your school so they can investigate.

3) Incident reports are confidential and viewable only by school staff and police.

4) False reporting of an incident is against state law and school policy.

What school are you or your student experiencing bullying at? *
What is your grade level? *
How long has this bullying been going on? *
When was the last bullying incident (MM-DD-YYYY)? *
MM
/
DD
/
YYYY
What time did this incident occur? *
Time
:
Please describe what happened and include as much information as possible. *
Your answer
Location of Incident *
What were the behaviors you experienced during the incident? *
Required
Did anyone else witness this incident? *
Please check one box
Required
Please list the name(s) of anyone who witnessed the incident(s).
Your answer
Have any school staff been notified about this incident? If so, who? *
Your answer
Would you like to be contacted? *
Your Name (optional)
Your answer
Your Email Address (optional)
Your answer
Your Phone Number (optional)
Your answer
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This form was created inside of Natomas Unified School District.