Brooklyn Schools Bullying, Harassment, or Intimidation Form
If you suspect a child you are aware of is being harassed, bullied or intimidated please fill out the below form. Upon completion of the form, please notify either the Elementary or Middle School depending on where the child attends through phone call or email immediately.
Email address *
Today's Date
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Person Reporting the Incident (Please include contact information)
Your answer
The person reporting this incident is... *
Required
Name of alleged student victim, age and school
Your answer
Name(s) of alleged witnesses (if known) including age and school
Your answer
Name(s)of alleged offender(s) (if known) including age and school
Your answer
Where did the incident happen
Check the statement(s) that best descries what happened (choose all that apply)
Did physical injury result from this incident?
Additional Pertinent Information that you would like the investigator to know
Your answer
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