Report Bullying
Thank you for taking the time to fill out this form. Please read the following before filling out the form.

If you're a student, don't forget to talk to your parents or guardians about the incident. If you need immediate help, contact Mrs. Battin.

Give as much information as possible so we can investigate.

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

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

Your name:
Your answer
Grade Level *
How long has the bullying been happening? *
Date of the last incident: *
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DD
/
YYYY
Time of the last incident: *
Time
:
Please describe what happened. *
Your answer
What was the location of the incident? *
Your answer
Behaviors that you experienced or witnessed during the incident: *
Required
Did anyone else witness the incident? *
Required
Please list the name(s) of anyone who witnessed the incident?
Your answer
Have any school staff been notified about this incident? If so, who? *
Your answer
Would you like to be contacted? *
How would you like to be contacted?
Your email and/or telephone number:
Your answer
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