Bullying, Harassment & Anonymous Incident Report
If you have any information regarding bullying/harassment or incidents and would like to report this information anonymously, please fill out the following form to the best of your ability and click submit. The description document linked below this may help guide some of your responses.

Please note:  Making false allegations, providing discriminatory statements and making defamatory statements is prohibited and engaging in such activity will be reported to the appropriate authorities.

If you fear that a student is in immediate danger, please call the Massena Police Department at (315) 769-3577, the New York State Police at (315) 769-3503, or 911.

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Person making the report: [OPTIONAL]
Contact information: [OPTIONAL]
Target/victim's name (first and last): *
Target grade: *
Alleged bully's name (first and last): *
Alleged bully's grade: *
Name of witness #1:
Name of witness #2:
Date of Incident: *
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DD
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Time of incident: *
Time
:
Frequency of incidents: *
How often have you witnessed this type of behavior?
Where did the incident happen? *
Which of the following best describes what happened? *
Describe what happened: *
If witnesses were involved, describe their role in the incident: *
List any evidence available of the bullying/harassment (letters, texts, posts, photos, etc.): *
Submit
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