Anonymous Bullying Report Form
To report bullying, please fill out this form. It is important that you be HONEST. Thank you for having the courage to speak up! You are helping everyone feel safe and respected at Evergreen.
Name and grade of person you believe WAS bullied:
Name and grade of person you believe DID the bullying:
WHEN did this happen?
For example, "Yesterday, during lunch" or "October 2."
Give as many details as you can.
How many times has this happened?
Name any other students or staff who saw or heard what happened:
If none, please write "N/A."
What else have you tried to address this situation?
Check all that are true.
Tried to talk with the person who was hurtful
Brought situation up in Class Meeting
Other (explain below)
If you answered "Other" above, please explain here.
This is completely optional.
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This form was created inside of Evergreen Community Charter School.