Carthage Central Online Bullying Reporting System
This form should be used to report alleged bullying, cyber bullying, or harassment in the Carthage Central School District. If you are a student target, the parent or guardian of a student target, a close adult relative of a student target, or a school staff member and wish to report an incident of alleged bullying, cyber bullying, or harassment, please complete and submit this form and it will be directed to the Dignity Act Coordinator at the student's school. Contact the school Dignity Act Coordinator for additional information or assistance at any time.

Administration will review and respond to each incident in the context of the Student Code of Conduct.

You may choose to report this information anonymously. All complaints will be treated in a confidential manner. Anonymous reports may limit the district's ability to respond to the complaint.

*False reporting of incidents will result in disciplinary consequences.

Today's date *
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Person reporting incident
Your answer
Phone
Your answer
Email
Your answer
Person completing this form *
Name of target *
Your answer
Name(s) of alleged offender(s) *
Your answer
Date(s) of incident *
Your answer
Where did the incident happen? (choose all that apply) *
Required
Place a check next to the statement(s) that best describes what happened (choose all that apply): *
Required
Background - please describe what happened before, during, and after the incident: *
Your answer
Who else saw the incident occur?
Your answer
What steps, if any, have been tried to resolve the issue?
Your answer
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