Harassment, Intimidation, and Bullying Report
Your Name: (Optional)
Your answer
Select the school: *
Who was the victim?
Your answer
Who was harassing, intimidating, bullying, or causing harm?
Your answer
Were there any witnesses?
Your answer
Date of incident:
Time of incident:
Cause of harassment, intimidation, bullying, or harm:
Method of harassment, intimidation, bullying, or harm:
Describe what happened:
Your answer
Is this the first time this victim has been bullied by this person?
I declare that this report is true to the best of my knowledge and belief, and that I understand that the contents will be used to assist students in need. *
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