Bullying Incident Report Form
If you have been the target of or have witnessed the bullying of a Troy R-III student, complete this form and click submit. Reports of bullying will be investigated and disciplinary action will be taken according to the handbook .
Email address *
Date Filed: *
MM
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DD
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YYYY
Your Name: (Students have the right to complete this form anonymously.)
Your answer
Indicate the appropriate response to the following: I am a... *
Dates of bullying incidents: *
Your answer
Name of Student subjected to bullying (the person being bullied): *
Your answer
Person(s) alleged to have committed the bullying or harassment (the bully): *
Your answer
Summarize the incident(s) or occurrence(s) of bullying as accurately as possible. *
Your answer
Name of witnesses:
Your answer
Have you reported this to anyone else? If NO, type No. If yes, tell us who. *
Your answer
Submit
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