Confidential Reporting of Bullying or School Violence
Reporting of Bullying or School Violence can help keep our school safe. If you are not comfortable reporting to your teacher, principal or the school counselor in person, use this form to report confidentially. Confidentially means nobody will know that you reported. You can still help someone who needs it or keep your school safe by using this to report! Thank you for caring about your classmates, teachers and staff!
Sign in to Google to save your progress. Learn more
Are you reporting Bullying or School Violence? 

Bullying is when someone is being mean or cruel with their words or actions toward another student.

School Violence means someone is saying they are going to bring a gun, knife or other weapon to school to hurt someone or doing something that makes you think they might do this.

It is always better to report something that you see or hear than to do nothing. It's better to be safe and let your principal check into it!
*
Where did this happen? We will ask you where at school later! *
What is the name of the person causing the trouble?  *
Who is being hurt by this person? *
When did this happen? *
Where at school did this happen? *
Did anyone else see what happened? If so, tell us who. *
Have you tried to tell anyone before? If so who? *
Tell us what you saw or heard the best you can! The more you can tell us the better chance we can help! *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Waltonville CUSD #1.

Does this form look suspicious? Report