SMHS Incident Reporting Form
Complete this form if you have credible information regarding a mistreatment incident that you would like to report. To report bullying and/or a crime anonymously, us the WeTip Hotline 1-800-78-CRIME or online at https://wetip.com/

This report will be investigated in a timely manner. If you fear a student is in IMMEDIATE danger, contact the appropriate resource i.e., the Principal, Assistant Principal, or Police Dept.

Formal disciplinary action may not be based solely on the basis of this report or an anonymous phone call.

Alleged Victim's Name *
(Last, First)
Your answer
Alleged Victim's Age
Your answer
Alleged Victim's Grade Level
Alleged Victim's Gender
Alleged Perpetrator's Name *
(Last, First)
Your answer
Alleged Perpetrator's Age
Your answer
Alleged Perpetrator's Grade Level
Alleged Perpetrator's Gender
Where did the incident occur? *
Be specific (i.e., classroom, hallway, restroom, cafeteria, parking lot, bus,)
Your answer
When did the incident occur? *
Time can be approximate.
MM
/
DD
/
YYYY
Time
:
Description of Incident *
Your answer
Where there any witnesses? *
Names of witnesses:
Provide their name(s) and contact information
Your answer
List any evidence of mistreatment.
(i.e., letters, texts, photos, etc)
Your answer
Was there a previous report filed by anyone regarding this incident? *
Required
When was the previous report filed?
MM
/
DD
/
YYYY
Was there a police report filed? *
Required
When was the police report filed?
MM
/
DD
/
YYYY
Have you been mistreated or witnessed mistreatment by this person before? *
Required
If so, how many times? *
Your answer
Was a report filed for the previous time(s)? *
Required
When was the report filed?
MM
/
DD
/
YYYY
Your email address:
Your answer
Submit
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