Submit Your Phone Incident Anonymously
Please note: This form is managed by an independent working group, Beacon Parents for Phone-Free Schools. The Beacon City School District is not maintaining it and BCSD staff are not reviewing what is shared. All responses are completely anonymous and will be treated with discretion.

We created this self-reporting form to raise awareness in our community. We hope the stories that are submitted can help us better understand the real impact of smartphones and social media in BCSD schools.

---------------------------------

Have you or your student(s) been impacted by a phone-related incident in BCSD schools? You are not alone. Once we start talking to each other, we discover that many of us have experienced such incidents.

We invite Beacon students, parents & caregivers, and teachers to share your stories firsthand — about how phones have led to unwanted incidents at school (and sometimes, beyond). This is a safe space for sharing. It takes just a few minutes to fill out this form.

Whether you are a student who has been impacted by phones, a parent whose child has been affected, or a teacher whose teaching has been disrupted, you can submit an anonymous phone incident report here. 

This is a completely anonymous Google Form, with no names or contact info attached. We will aggregate the data points for any reporting purposes, and if we share any excerpts of stories shared, they will be anonymized.

Thank you for sharing your story. If you would like to get involved with our working group, ask a question, or share more, please email us at BCSDphones@gmail.com.
Sign in to Google to save your progress. Learn more
What is your role in BCSD schools? *
For the phone-related incident you are reporting, what was the nature of the incident? (Check all that apply) *
Required
Please share a brief description of what happened. Please do not use any identifying names of students or staff — if needed, use "student 1," etc.

If you were directly affected by the incident, please feel free to share how you felt and/or how you feel about it today.
 *
Where did this incident happen? (Check all that apply) *
Required
When did this incident happen? (Season / year format please, for example: Fall 2024) *
In what grade(s) were the student(s) involved? (Check all that apply) *
Required
Was this incident reported to school staff? *
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms