Anonymous Bullying Reporting
This form is being provided as a reporting mechanism for bullying. Please fill out the form entirely. Every report will be investigated and responded to appropriately. Thank you for your role in eliminating bullying!
Who was being bullied? (First and Last Name)
Who was bullying the individual/group named above? (First and Last Name(s)
Who is reporting this instance of bullying?
I am the person being bullied
I witnessed the person being bullied
Someone told me that this person was being bullied
Please provide the name(s) of any witnesses to the bullying (First and Last if possible).
Please provide as much information as possible regarding this situation. The more information that is provided, the better chance of our staff successfully addressing the bullying situation.
Has this been reported to any adults in the building? If so, who?
Never submit passwords through Google Forms.
This form was created inside of Summersville Grade School.
Terms of Service