Tell Someone

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Tell Someone

An anonymous reporting form for bullying & safety issues at Smithton School District

Name: *

If you wish to remain anonymous, please enter "none" on this line

Please categorize your concern. Check all that apply. *

Harassment/Bullying

Cheating and/or Academic Dishonesty

Depression and/or Anxiety

Self Harm and/or Suicide

Drugs and/or Alcohol Abuse

Verbal and/or Emotional Abuse

Physical Abuse

Sexual Abuse

Other:

Required

Name of 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 a situation, the better we are able to help. If you witnessed something happening, please give specific locations (ex: outside Mrs. Jones' classroom OR in the boys bathroom outside the gym).

When did this incident occur? *

Name of the person(s) causing harm (if you know):

Is there anything else we should know? *

This form will be submitted anonymously once you click the "Submit" button. However, many times we need additional information in order to help a student. Please know that 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, please leave this question blank.

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This form was created inside of Smithton CCSD #130. Report Abuse

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