Southridge High School Anonymous Bullying Report Form
Southridge High School is committed to providing students with a safe and nurturing learning environment.  This form is provided to allow for the anonymous report of a bullying incident.  This form will allow the Southridge High School staff to investigate any allegations and, if they are substantiated, pursue the proper course of action in response to a report of bullying.  
Sign in to Google to save your progress. Learn more
Name of Victim/Victims *
Name of Bully/Bullies *
Name of any bystanders/witnesses who may have witnessed the event.
Not required
Where did the incident happen? *
Include specific details about the location (room number, hallway area, etc.)
When did this incident happen? *
Include specific details including a date and time (between classes, at the morning bus stop, etc.)
Describe the incident with as much detail as possible. *
If you would like to be contacted, please type your name here.
Not Required
I hereby confirm that I have truthfully reported this incident and that my report contains no false allegations or information. *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Southwest Dubois County School Corp.. Report Abuse