BULLYING REPORTING FORM
You can anonymously report an instance of bullying using this form.
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.
Please choose the campus that the incident occurred.
Abell Junior High
Alamo Junior High
Bowie Fine Arts Institute
Coleman High School
De Zavala Elementary
Early College High School @ MC
General Franks Elementary
Goddard Junior High
Lee Freshman High School
Lee Senior High School
Midland Alternative Program
Midland Freshman High School
Midland Senior High School
Pease Communication & Technology
San Jacinto Junior High School
Santa Rita Elementary
Washington STEM Academy
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.
If student, state your grade
Check whether you are the
Target of the behavior
Reporter (not the target)
Check whether you are a
Name of Aggressor
(Person who engaged in the behavior.)
Your contact information telephone number
(This information isn't required, but will be helpful should additional information be needed)
Please describe the incident. Details regarding the incident must be provided.
Name of Target (of behavior)
Date of Incident(s)
Time when incident Occurred:
Location of Incident (Be as specific as possible.)
Witnesses 1 (List people who saw the incident or have information about it.)
Witnesses 2 (List people who saw the incident or have information about it)
Witnesses 3 (List people who saw the incident or have information about it)
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