An anonymous reporting form for bullying and safety issues.
Please categorize your concern. Select all that apply.
Depression and/or Anxiety
Self Harm and/or Suicide
Drugs and/or Alcohol Abuse
Name of the person you are concerned about:
Information About Your Concern: Please give as much detailed information about your concern as possible. The more information we have about the situation, the better we are able to help. If you witnessed something happening, please give specific locations (ex: Upstairs hallway by Mr. Smith's room; the boy's bathroom by the cafeteria, etc).
When did this incident occur?
Is there a specific time this is happening?
Name of the violator(s) or person(s) causing harm:
This form will be submitted anonymously once you hit the "submit" button. However, many times we need additional information in order to help a student. Please know we would not share your name with the person you are concerned about unless you approve it first. We will simply say it was submitted by someone who is concerned about them. If you are willing to provide us with your name, please enter it below. If you would rather remain anonymous, you may skip this question and continue on to submit this form anonymously.
Is there anything else we should know?
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This form was created inside of Columbia Community Unit School District #4.
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