Safe To Say: Report Bullying or Suicide Prevention

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Complete this form to report a bullying incident or for suicide prevention. You do not have to include your name if you wish to remain anonymous. The campus principal and superintendent will be notified once this form has been submitted. False reporting by students will result in disciplinary action. If you are experiencing a problem that needs immediate attention, tell a teacher, school leader, or other trusted adult as soon as possible. If this is an emergency, call 911.

I am *

Situation *

I think I was bullied.

I was a witness to what I think was bullying.

I was informed of possible bullying.

I am having or had thoughts of hurting myself.

I heard of someone having thoughts of hurting themself.

Other:

On which campus is the person possibly being bullied or harming themself? *

Where did the possible bullying or harmful thoughts occur? *

Name of the student possibly being bullied or thinking of harming themself.

What happened or what did you hear? (Please provide specific details including name(s), bus number, bus driver name, campus, classroom etc. if available) *

May we contact you? *

yes

Your name

Your Phone Number

Your Email *

Disclaimer *

I declare that this report is true to the best of my knowledge and belief, and I understand the content will be used to assist students in need.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Redwater ISD.

Does this form look suspicious? Report

Forms