Northampton County Schools Anonymous Bullying
Northampton County Schools Board of Education acknowledges the dignity and worth of all students and employees and strives to create a safe, orderly, caring and inviting school environment to facilitate student learning and achievement. The board will not tolerate any form of unlawful discrimination, harassment or bullying in any of its educational or employment activities or programs. If you or someone you know has been bullied, you may use this anonymous form to report the act. Submissions of this form are completely anonymous and confidential. Each submission is acted on in a timely manner. For student bullying, the form will be forwarded to the appropriate school executive for investigation. For employee bullying, the form will be forwarded to the Northampton County Schools Human Resource Department for investigation. You may view the Northampton County Schools Board of Education Policies at
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Have you reported this incident to anyone in authority? (Examples: teacher, school counselor or school executive)
Identification of Victim
What is the name of the person being bullied?
Which school does the victim attend/work?
Gaston STEM Leadership Academy
Northampton County High School
Northampton Early College
Willis Hare Elementary
Location of Incident
Where did the incident occur?
Date(s) of incident(s)
When did the incident(s) occur?
Identification of Bully
What is the name of the alleged bully?
Status of Bully
What school status does the alleged bully hold?
Status of Person Reporting Incident
What is your status?
Person being bullied
Name of Person Reporting Incident (Optional)
What is your name?
Description of Incident
Describe the incident in concrete, behavioral terms; be specific. Your description of the incident is what other people will rely on to obtain information concerning the individual and the incident.
Did you witness the event?
List other individuals (school employees, students, or parents) who may have witnessed the event.
Provide any additional information in the area below.
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This form was created inside of Northampton County Schools.