Anonymous Bullying Report Form
If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge.  Please note that this form is completely anonymous.  
(For the purpose of this form, bullying encompasses bullying, harassment, and discrimination.)

Sign in to Google to save your progress. Learn more
Victim First and Last Name
Person who was being bullied. Example - Bob Jones
Is the victim male or female?
What grade is the victim In?
How old is the victim?
Accused Name
Person who was doing the bullying - Example - Bob Jones
Is the accused male or female?
What grade is the accused in?
How old is the accused?
Where did the incident occur?
What date did the incident occur?
Example 10/02/12
What time of the day did the incident occur?
Example 10:30am
Please describe in as much detail as possible, what happened.
List any other witnesses' names and grades.
List evidence of bullying if any (i.e. letters, photos, etc. - attach evidence if possible.)
Thank you.
This report will be followed up within 2 school/work days.  If you fear a student is in IMMEDIATE danger, call 911.
Clear form
Never submit passwords through Google Forms.
This form was created inside of Vanlue Local School. Report Abuse