Anti-Bullying Report Form
If you have information regarding a bullying incident and would like to report this, please fill out this Anti-Bullying Report form to the best of your knowledge. Please note that this form can be completely anonymous. Bullying is a serious issue and will not be tolerated. Use this form to report bullying that occurred on school property; at a school-sponsored activity or event off school property; on a school bus; on the way to and/or from school; on social media or through text message, during the current school year.
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Email *
Your Personal Information - Name, Address, Phone (Optional)
Date of Bullying
MM
/
DD
/
YYYY
Time of Bullying
Time
:
Name(s) of People Involved
Address of Where the Bullying Took Place
Description of What Happened *
I am submitting this form based on my belief that I have been a victim of bullying, or someone I know has been bullied. I am reporting this because I am concerned and I want the situation to be better in the future. I certify these statements to be true and accurate.
A copy of your responses will be emailed to the address you provided.
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