Bullying Form
Please fill out this electronic form to report any incidents or concerns regarding bullying and harrassment. This form can be automatically submitted to the Eldred Central School District by clicking the "Submit Form" button at the bottom of the page.

The accused individual will not be shown this report. This is a CONFIDENTIAL report and due to privacy laws, you will likely not be notified of the outcome of the school district's investigation.

Your name (this will help us to investigate the incident)
Your answer
Your email (providing a contact will enable us to secure additional information, if needed.)
Your answer
Your are? (check appropriate box - required) *
Comments
Your answer
Date of complaint(required) *
Your answer
Time of incident(s) (choose all that apply - required) *
Required
Detail of the time of incidents (above)
Your answer
Describe the incident(s). Choose all that apply -required *
Required
Comments
Your answer
Do you know the name of the person being bullied? (required) *
Please provide name if know:
Your answer
Please provide name of any witnesses:
Your answer
What school does the person being bullied attend?
Please share any additional information or comments here:
Your answer
Submit
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