Westerly Middle School - Bully Reporting Form
Email Address *
Your answer
Your Name (optional, but helpful):
Your answer
I am a *
Alleged Bully *
Your answer
Alleged Victim *
Your answer
Witnesses/Bystanders
Your answer
Select the statement(s) that you believe best describe what happened (choose all that apply). *
Required
Electronic communications used to bully (select all that apply): *
Required
Harassment (select all that apply):
Location(s) (select all that apply): *
Required
Date and Time this happened *
Your answer
What sort of help would you like with this issue? *
Your answer
Have you told anyone else about this incident? if yes, who? *
Your answer
Describe the situation. The more detail you provide the better. *
Your answer
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