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.
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I am a: *
Type the name(s) of the student(s) you are reporting.   *
What school do these students attend?
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What grade are you in? *
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
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)
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