Central Academy Anonymous Bullying Form
This form is anonymous and confidential and should only be used when you are feeling a real concern for the physical, social, and emotional well-being of yourself or a fellow student. Upon submission of this form a request will be sent anonymously. If you feel this is an emergency, we encourage you to report this immediately to a trusted adult.
Please type below the name of the student about whom you are concerned.
Where did the incident you are reporting happen?
Please describe the problem or incident you witnessed/heard about which you are concerned.
What is the approximate date and time this incident occurred?
If you would like to leave your name, please do so below.
This is optional and not required to submit the form.
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This form was created inside of Cape Girardeau Public Schools.
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