Chariho Middle School Bullying or Cyber Bullying Report Report Form 2025-2026
Please answer the following questions about this Bullying Reporting Incident.                                                 Please note: this report will remain confidential.
Email *
Name of individual who is submitting this form: *
Student First Name: *
Student Last Name: *
Student ID
Student Grade Level: *
Reporting Date *
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Date of Incident: *
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Report Time:  *
Time
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School
List the name of the alleged bully, and/or cyberbully. If name is not known, provide any other identifiable information.
Relationship between you and the alleged bully, and or cyberbully:
Describe the Incident: *
When and where did it happen?
Were there any witnesses?
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If there were witnesses, who were they?
Other information, including previous incidents or threats:
By clicking the "submit" button you are certifying that all statements made in the complaint are true and complete. Any intentional false statement of fact will subject me to appropriate discipline. I authorize the school officials to disclose the information I provide only as necessary in pursuing the investigation. 
A copy of your responses will be emailed to .
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