Student Bullying Report Form
PLEASE USE THIS FORM TO REPORT BULLYING YOU HAVE EXPERIENCED OR WITNESSED.

To enable us to deal with this matter effectively, please answer all questions fully, providing as much detail as possible.
Email address *
Your Name *
Your answer
Your Tutor Group *
Your answer
Who is being bullied? *
Your answer
Name(s) of alleged bully(ies) *
Your answer
How often does this happen? *
Never happened before
Every couple of months
1 - 2 times per month
1 - 2 per week
Every day
(select one)
How long has this been going on? *
Less than a week
1 -2 weeks
3 - 4 weeks
More than a month
6 months or more
A year or more
(select one)
What has been happening? *
Please provide as much detail as possible.
Your answer
Who else may have seen what has been happening?
Think of where you were when this happened and who else was around at that time.
Your answer
This reporting service can be used at any time, however, it is monitored between 0800 and 1530, Monday to Friday, during term time. Reports submitted outside of these hours will be received the next working day. If you wish to speak with someone outside of these hours, please contact Childline on 08001111. If you or another person are in immediate danger or at risk of harm, dial 999 and ask for the Police.
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