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Report a Bully or Harassment
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* Indicates required question
Email
*
Your email
Please select the school involved with this report.
*
Bath Elementary School
Chocowinity Middle School
Chocowinity Primary School
Early College High School
Eastern Elementary School
Education Technical Center
J.C. Tayloe Elementary School
John Small Elementary School
Northeast Elementary School
Northside High School
P.S. Jones Middle School
S. W. Snowden School
Southside High School
Washington High School
Required
Have you reported the incident to a school administrator?
*
Yes
No
If you answered yes, please tell us who you reported the incident to initially.
Your answer
Are you a
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student
parent/guardian
Other:
Please tell us the name of the person(s) being bullied or harassed.
*
Your answer
Do you know the name of the alleged offender(s)?
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Yes
No
Name of offender(s)
Your answer
Were you an eyewitness to the event?
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Yes
No
Please provide the name and grade of any other eyewitnesses.
Your answer
Where did the event in question occur? Be as specific as possible.
*
Your answer
What was the date of the event?
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MM
/
DD
/
YYYY
What time of day did the event in question occur? Be as specific as possible.
*
Your answer
If there were multiple events, please add addition dates and times. Please be as specific as possible.
Your answer
Please select the type of bullying or harassment you are reporting. Choose as many as apply.
*
Physical: hitting, kicking, or other acts of physical aggression.
Verbal: teasing, name calling, putdowns
Emotional: exclusions, starting rumors
Cyber-bullying: use of an electronic medium to engage in bullying or harassment
Other:
Required
What other information would you like to report?
Your answer
By submitting this information, I am verifying this is a true report.
*
Yes
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