BULLYING REPORTING FORM
You can anonymously report an instance of bullying using this form.
Campus
Please choose the campus that the incident occurred.
Name of Reporter/Person Filing the Report
Note: For reports made anonymously the District will not be able to contact the reporter with results of the investigation.
Your answer
If student, state your grade
Your answer
E-Mail Address
This is not required, but you will need to submit a valid email address, if you would like to have a copy of your responses.
Your answer
Check whether you are the
Check whether you are a
Your contact information telephone number
(This information isn't required, but will be helpful should additional information be needed)
Your answer
Information about the incident
Name of Target (of behavior)
Your answer
Name of Aggressor
(Person who engaged in the behavior.)
Your answer
Date of Incident(s)
MM
/
DD
/
YYYY
Time when incident Occurred:
Time
:
Location of Incident (Be as specific as possible.)
Your answer
Witnesses (List people who saw the incident or have information about it.)
Name:
Your answer
Witnesses (List people who saw the incident or have information about it)
Name:
Your answer
Witnesses (List people who saw the incident or have information about it)
Name:
Your answer
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