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.
Today's Date *
MM
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DD
/
YYYY
Name and grade of person you believe WAS bullied: *
Your answer
Name and grade of person you believe DID the bullying: *
Your answer
WHEN did this happen? *
For example, "Yesterday, during lunch" or "October 2."
Your answer
What happened? *
Give as many details as you can.
Your answer
How many times has this happened? *
Your answer
Name any other students or staff who saw or heard what happened: *
If none, please write "N/A."
Your answer
What else have you tried to address this situation? *
Check all that are true.
Required
If you answered "Other" above, please explain here.
Your answer
Your name
This is completely optional.
Your answer
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