FMS Bullying Report Form 2018-2019
Student responses will be sent to the principals and counseling office. You are not required to include names, but knowing the name(s) of the people involved helps us investigate as thoroughly as possible. So, please include this information if you feel comfortable doing so.
Email address *
Date of Event *
MM
/
DD
/
YYYY
Location of Incident *
Use "Other" if you have an exact location.
Time of Event *
If you do not know the exact time of the incident, pick an approximate time
Time
:
I am a:
If you are a student, select your current grade. *
Your Full Name (optional)
Your answer
Witnesses or Bystanders:
Who else saw this happen? If no one else observed, it is okay to leave this blank.
Your answer
Name(s) of student(s) being bullied or targeted: *
Grade AND/OR Class
Your answer
Name(s) of student(s) bullying: *
Your answer
Describe the Incident: *
Describe what happened. Include the names of people involved, if you know them. Also include what each person said and did.
Your answer
How many times has the incident happened?
Your answer
Have you told anyone about this before?
If so, who?
Your answer
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