Jefferson: Reporting Form
Please use this form to anonymously report any form of bullying, harassment, physical altercation, or substance abuse on campus. Your submission will be investigated, thank you for taking the time to report the incident.
Entering your name is optional.
Your answer
Please check off your grade level *
If you are a parent, guardian, or community member reporting an issue, please check off other and type in your response.
When did the incident occur? *
If multiple dates, pick the most recent incident. If you do not know a date, give an approximation.
Is the incident happening over any online social media outlet? *
If you answered NO to the question above, where did this incident take place?
Name of the Victim *
Person who is being victimized or bullied. This is a required question to submit the form
Your answer
Please give a brief description regarding what you know about the situation that happened or has been occurring. *
This is required to be able to submit.
Your answer
Name of the Suspect
Person who is bullying or causing the incident. If you do not know the person's name, please leave it blank.
Your answer
Never submit passwords through Google Forms.
This form was created inside of Kings Canyon Unified School District. Report Abuse