Anonymous Reporting Tip Line
Please use this form for communicating bullying, harassment, and concerns. Your communication can be anonymous or you are welcome to include contact information to allow us to ask additional questions if needed.
If you believe someone is in immediate and life-threatening danger, please indicate below.
Your name: (optional)
I am a: (If other, please specify in the area provided.)
I have reported this event/situation to my school:
Please indicate the type of report:
Cyberbullying or online bullying - bullying or harassment using electronic means such as cell phones, computers, and tablets.
Emotional/social bullying - intentionally excluding someone, spreading rumors, and embarrassing someone
Physical bullying - intentionally hurting someone's body by hitting, punching, spiting, tripping, pushing, etc.
Verbal bullying - teasing, name-calling, taunting, threatening harm, or inappropriate sexual comments
Harassment/Discrimination - behavior toward someone based on race, national origin, color, sex, age, disability and/or religion.
Name of person (bullied or harassed):
School or location person attends:
Alexander Early College
Alexander Central High School
Bethlehem Elementary School
Central Office (Board of Education)
East Alexander Middle School
Ellendale Elementary School
Hiddenite Elementary School
Stony Point Elementary School
Sugar Loaf Elementary School
Taylorsville Elementary School
West Alexander Middle School
Wittenburg Elementary School
Student Success Center
If known, name of person doing the bullying or harassing.
Were you present when the incident occured?
List of other students or adults who witnessed the incident or situation: (If no witness, enter NONE)
Who has been told about they incident or situation?
Other adult in the school
Sibling (brother or sister)
Where did the incident occur? (Check all that apply)
In class while teacher was in the room
In class while teacher was out of the room
What date did the incident occur?
Please describe in detail what happened: (include when and where the incident occurred)
Best way to contact you:
I do not want to be contacted
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