Bully Report Form
This form can be used to fill out if you or someone you know is being bullied and you do not have the opportunity to report the bullying in person to the school principal, counselor, or designated teacher. Forms can be dropped off to any staff member, the school office, or dropped off in the building's reporting box.
Reporters Name (If you wish to share)
Your answer
Reporters Grade *
Required
Are you the person who is allegedly being targeted for bullying? *
Required
If "No" to question two, who is the target of the bullying?
Your answer
Who is the alleged bully?
Your answer
Alleged Bully's Grade Level
Where did the alleged bullying occur? *
Required
Was the alleged bullying physical, verbal (relational), or cyberbullying? *
Required
Please describe the incident *
Your answer
Submit
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