Bullying Report Form
Instructions: Complete this form, responding only to the questions that you feel comfortable answering and are able to report accurately. This form may be completed by the person reporting the incident or by the school employee to whom the incident is being reported.
* Required
Name of Person Reporting the Incident:
Your answer
School
*
Choose
Bayou Blue Elementary School
Bayou Blue Middle School
Bayou Blue Upper Elementary School
Bayou Boeuf Elementary School
Career Magnet Center
Central Lafourche High School
Chackbay Elementary School
C.M. Washington Elementary School
Cut Off Elementary School
East Thibodaux Middle School
Galliano Elementary School
Golden Meadow Lower Elementary
Golden Meadow Middle School
Golden Meadow Upper Elementary
Larose-Cut Off Middle School
Lockport Lower Elementary School
Lockport Middle School
Lockport Upper Elementary School
North Larose Elementary School
Raceland Lower Elementary School
Raceland Middle School
Raceland Upper Elementary School
Sixth Ward Middle School
South Lafourche High School
South Larose Elementary School
St. Charles Elementary School
Thibodaux Elementary School
Thibodaux High School
W. S. Lafargue Elementary
West Thibodaux Middle School
Date of Report:
*
MM
/
DD
/
YYYY
Person Reporting the Incident:
Choose
Student
Parent/Guardian
School Employee
Chaperone
Description of Incident (Include the names of those involved and as much detail as possible: what, where, when, how, etc.)
Your answer
List the name(s) of any witnesses to the incident.
Your answer
I agree that all of the information on this form is accurate and true to the best of my knowledge.
Your answer
Submit
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