JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bully Report
Please use this form to report any bullying or concerning behavior you're seeing at home or at school.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Today's Date
*
MM
/
DD
/
YYYY
Name of Student Reporting Bullying
**You are not required to leave your name.
Your answer
Name of Student Who Is Bullying
*
Your answer
Name of Student Being Bullied
*
Your answer
Where did this bullying happen?
Classroom
Bus
Online
Hallway
Lunch Room
Athletics/Activities
Home
Other:
Please explain what happened. If you're using this to report someone who is thinking of hurting themselves or you are thinking of hurting yourself, please contact a trusted adult or call 911.
*
Your answer
By clicking "submit" you are agreeing that the information you're sharing is accurate to the best of your knowledge and done with positive intentions. It is neither false nor misleading.
*
I agree
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of DeKalb CUSD428.
Does this form look suspicious?
Report
Forms
