CJHS Bullying Report
This form is a way to report bullying happening to you or someone else at CJHS. After submitting this form, your response will be sent to administration. They will then follow up with the individuals involved.
What is your Name? (You may report anonymously, however the investigating administrator may need more information than is provided in order to appropriately respond)
Your phone number or email address (You may report anonymously, however the investigating administrator may need more information than is provided in order to appropriately respond)
What role are you reporting as?
Please check the following boxes that apply:
the behavior was intentional; intended to cause harm to someone
the behavior was repeated; happened 2 or more times
The behavior is harmful; it causes emotional or physical harm to another
there is an imbalance of power; one party has more control or power over the other
Where and when did this incident occur?
Please describe the incident(s)
Please be as detailed as possible. Including names of those involved is important to be able to follow up on this situation.
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This form was created inside of East Peoria District 86.