Bullying Report Form
*Required

“Bullying" means any pattern of harassment, intimidation, threatening behavior, physical acts, verbal communication, or electronic communication directed toward a student or group of students that results in or is reasonably perceived as being done with the intent to cause negative educational or physical results for the targeted individual or group; and is communicated in such a way as to disrupt or interfere with the school's educational mission or the education of any student.

This is not an emergency reporting system. If this is an urgent matter, please dial 911 immediately.

We can offer this reporting site anonymously. However, we can't guarantee that we can follow-up with you unless we have your name and a way to contact you by either phone or e-mail.

This system is designed to help students, parents and community members anonymously report past, present and predicted crimes in our school community. This report is not intended to replace direct contact with school administration. You may contact any school building or the district office with any issues or concerns you may have, or report the incident here.
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Please select your school from the drop-down list *
Reporting Person: First name, Last Name (Leave blank if anonymous report)
Contact information: (Leave blank if anonymous report)
Incident Date?  (Must contain a date in M/D/YYYY format) *
MM
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DD
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YYYY
Incident Time? *
MM
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DD
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YYYY
Incident Location? *
Is this the first time there has been a "bullying" issue between you and the reported bully? *
If "No" was selected, briefly describe other incidents between you and this person(s)?
Please list all persons you are reporting as a victim *
Please list all persons who participated in the bullying behavior. *
Who were witnesses to the incident? *
Do you have physical evidence of the incident?  (Check all that apply) *
Required
Other evidence (please specify)
Describe this incident in detail.  Please include dates, times and locations to the best of your ability.  Please list anyone else who is a victim. *
I agree that all of the information is accurate and true to the best of my knowledge.  Signature (Type name - not required if reporting anonymously.)
Must contain a date in M/D/YYYY format *
MM
/
DD
/
YYYY
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