CH High School Bullying Incident Report

Are you being bullied, harassed, or picked on? Do you know someone else who may be? You can use this form to ANONYMOUSLY report what is going on. All reports will be kept confidential if that is what you want.

The District prohibits bullying on school property, at school-sponsored or school-related activities, or in any vehicle operated by the District. Bullying may include verbal or written expression, expression through electronic means, or physical conduct. Bullying is not tolerated by the District, and any student or parent of a student who believes that the student or another student has experienced bullying or that a student has engaged in bullying is encouraged to immediately report the incident. Retaliation against anyone involved in the reporting process is a violation of District policy and is prohibited.

Students or parents may report an alleged incident of bullying, orally or in writing, to a teacher, counselor, principal or other District employee. Students or parents should use this digital form to submit a report. 

Date of Report Being Submitted - Today's Date *
MM
/
DD
/
YYYY
Name of student who was being bullied?  *
Grade of student who was being bullied. If you do not see the desired grade, please go directly to that campus website and click on the correct bullying report form. This form is for CH High School students.  *
Name of person engaged in bullying? *
Date of the Incident *
MM
/
DD
/
YYYY
Grade of person engaged in bullying? *
What type of bullying? *
Where did the incident take place? *
Please explain what happened with as many details as possible.  *
***OPTIONAL: Name of person reporting the incident. Include cell phone number. 
May we contact you for more information? 
Clear selection
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Central Heights ISD.

Does this form look suspicious? Report

Google Forms