Anonymous Bullying Report
Central Middle School takes acts of bullying seriously for students. If you, or someone you know has been bullied, please use this anonymous form to report the act to the administration. This form does not track who sent the report. For student bullying, the submitted report will then be forwarded to the appropriate school administrator for investigation.
I have reported this incident to my school. *
Approximate date of the incident. *
Your answer
Who was it reported to? *
Your answer
Name of person allegedly being bullied. *
Your answer
Alleged location *
Name of person allegedly bullying *
Your answer
The alleged bully is a: *
Your Name (optional):
Your answer
Type of alleged bullying *
Required
Description of events (Please be specific--Location/Date/Time): *
Your answer
Did you witness the alleged bullying incident? *
List other students/staff who witnessed the event: *
Your answer
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