JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Lexington Bullying Reporting Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Email
*
Your email
Today's Date
MM
/
DD
/
YYYY
I am:
Victim
Witness
Staff Member
Parent/Guardian
Community Member
Other
Clear selection
Name of Alleged Bully (unknown if name not known)
Your answer
When did the event occur?
MM
/
DD
/
YYYY
Where did the event occur?
Hallway
Classroom
Locker Room
Lunch Room
Bus
Other
Clear selection
Please accurately and specifically describe the incident:
Your answer
Has the bully done this to the same victim on other occasions?
Yes
No
Don't Know
Clear selection
Your name (if you are comfortable sharing it):
Your answer
Names of any others involved:
Your answer
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
Privacy
Terms
This form was created inside of Lexington CUSD #7.
Report Abuse
Forms
