IES Bullying Report
Please complete this form to the best of your knowledge so we can assist you.
This information will be kept confidential with your campus administrator and/or superintendent.
Date of Incident
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Date of Report
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YYYY
Who was the person(s) engaged in bullying?
Your answer
Grade of person(s) who engaged in bullying?
Your answer
Who was being bullied?
Your answer
Grade of person who was being bullied?
Your answer
What type of bullying?
Where did the incident take place?
Other location details: (Please explain the specific location details such as which hallway, where on the Internet, what restroom, etc)
Your answer
Describe what happened with as many details as possible.
Your answer
Person reporting the incident:(OPTIONAL). Please use your full name.
Your answer
May we contact you for more information on this incident?
Thank you for reporting this incident. We appreciate your concern. When you click "Submit Form" this will be sent to the campus administrator.
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