QPS Bullying Reporting Form

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Quincy Public Schools is committed to providing a safe learning environment for all students and will not tolerate bullying of any kind.

Please use this form to report incidents of bullying at Quincy Public Schools (Quincy, MA) to the Senior Director of Student Support Services. Please note: this form is anonymous unless you provide your contact information at the bottom.

Once the Senior Director of Student Support Services receives this submission, a preliminary investigation of the incident will begin.

Thank you for helping to eliminate bullying at QPS!

School at which incident took place

Please describe the incident.

Please name or describe the offender(s) and the victim(s)

Where did the incident occur? (e.g. cafeteria, bus, off-campus, classroom, etc.)

On what date did the incident occur?

YYYY

At approximately what time did the incident occur?

Time

What was your role in this incident?

I was involved

I was a witness

I am the parent/guardian of a student involved

I am a QPS staff member or volunteer who was told about the incident

I am a student who heard about the incident by someone else

Other:

Clear selection

Would you like someone to contact you to follow up on this report? If so, please provide your name and contact information (optional.)

Submit

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