Palombi Middle School maintains a policy prohibiting all forms of bullying. This form is sent to the appropriate school personnel, who will investigate your report and respond as necessary. Any student who knowingly makes a false accusation of bullying shall be subject to disciplinary action.
Your name (optional, but helpful):
Please understand, without providing your contact information it may be difficult to pursue this report.
I am a:
My grade level is:
Describe what happened:
* Include information on the bully, victim, any witnesses/bystanders; the more detail you provide the better.
Date and time this happened:
Would you be willing to talk to the principal, school social worker, or school psychologist about this incident?
What sort of help would you like with this issue?
Have you told anyone else about this incident? Who?
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This form was created inside of Lake Villa School District 41.