Anonymous Bullying Incident Report
Please complete the bullying incident report. This report is anonymous. If you have an immediate concern, please contact your school's principal.
I am a: *
During this incident I was a: *
Type the name of the student(s) who are bullying and the school they attend. *
What grade are you in? *
What is the name of the student you would like to report? *
If you do not know the name of the student, please describe the person.
Where did this incident take place? *
Please describe the incident. *
Were there witnesses to this incident? (if known) *
What are the names of the witnesses?
Please rate the severity of this incident. *
1 being minor incident but unacceptable to 5 being major incident
Minor
Major
Please describe the frequency with which this type of incident occurs. *
Would you like to speak with a counselor? *
You must add your name below if you want a counselor to follow up with you.
What is your name (optional)
What else would you like us to know about this incident? (optional)
Submit
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