Report Bullying
This will be monitored during regular business hours Monday - Friday from 8:00 a.m. - 4:00 p.m. (excluding holidays, weekends, and non-school days for students). 
Email *
Who was being bullied, harassed, intimidated, or harmed? (First & Last Name) *
Please indicate the grade level of person being bullied, harassed, intimidated, or harmed. *
Please indicate the date of this incident. *
When did this incident occur? *
Where did this incident happen? *
Was this cyberbullying? *
If possible, please tell us who was bullying, harassing, intimidating, or causing harm? (First & Last Name) *
Describe what happened. Please give as much information as you can, including any witnesses. *
If known, how many times has this situation occurred? *
Was this incident reported to an adult or staff member? If so, who? *
Tell us who you are. *
Email *
Phone number *
Clear form
Never submit passwords through Google Forms.
This form was created inside of Learning Lodge Academy. Report Abuse