Anonymous Bullying Form
If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge. Please note this form is completely anonymous.

For the purpose of this form bullying is defined as:
Intentionally harmful, negative behavior toward a target possibly with less power than the bully. The behavior(s) may or may not be repeated.
Name of Target (Target- person/people being bullied) OPTIONAL:
Your answer
What grade is the target in? *
Name of the bully:
Your answer
What is the date the incident occurred?
MM
/
DD
/
YYYY
Did you witness the bullying incident? *
Were you the target of the bullying incident? *
Where did the bullying incident take place? Bathroom Hallway Bus Cafeteria Classroom Other, please specify *
Please describe, in as much detail as possible, what happened. *
Your answer
Please list the names of any bystanders that witnessed the bullying (optional):
Your answer
List any evidence of the bullying incident(s) (i.e. letters, pictures, texts, e-mails, etc.) *
Your answer
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