Anna-Jonesboro High School Alleged Bullying Report
Use this form to report bullying you experienced or witnessed. Feel free to fill out as much or as little of this form as you feel comfortable with sharing. The more information you provide, the easier it will be to follow up on this behavior
What happened?
Please describe the bullying or harassment in as much detail as possible.
Where did the bullying occur?
Was the bullying in the classroom, before school, in the hallways, at lunch, at home or online?Your answer
What type of bullying happened?
Clear selection
Was the bullying or harassment over one of these issues?
Please indicate if the incident seemed to be motivated by one of these issues.
Clear selection
On what day did the bullying occur?
MM
/
DD
/
YYYY
At what time did the bullying occur?
Time
:
Was there physical injury?
Clear selection
Who was being bullied or harassed? *
List the names of the person(s) who were bullied or harassed.
Who did the bullying or harassment? *
List the names of the person(s) doing the bullying or harassment.
Were there other witnesses?
If you answered 'Yes' to the last question, please describe the previous bullying or harassment that you witnessed.
Is there any kind of proof?
Clear selection
Are you willing to share the proof?
(Photo, Email, Website, Social Media) Please paste a website link to proof if you can.
Prior to this incident, have you witnessed other acts of bullying or harassment involving these persons?
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