ACS Bullying and Harassment Online Reporting Form

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This is a form to report alleged bullying and/or harassment. You can submit a report for yourself or an anonymous report for someone who is being bullied and/or harassed. This incident will be addressed by ACS administration within 24 hours.

Email *

Record my email address with my response

Alleged Victim's First and Last Name *

Alleged Perpetrator(s) First and Last Name(s)
*

Date of Alleged Incident
*

YYYY

Who is reporting this incident?
*

Friend/Student

Self-Referral

Staff

Parent/Guardian

Category of Bullying (please check all that apply)
*

Physical

Verbal

Electronic (please provide evidence)

Other

N/A

Required

Please provide a brief, detailed summary of incident.
*

Name of person initiating this report. Please indicate "anonymous" if you do not want to provide your name.
*

Send me a copy of my responses.

Submit

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