Anonymous Report for Harassment, Intimidation, and Bullying (HIB)
Alleged Victim: *
Your answer
Location of alleged HIB incident. *
Check all that apply.
Required
Alleged Bully: *
Your answer
Date of Alleged Incident: *
MM
/
DD
/
YYYY
School:
Check all that apply
Describe the nature of alleged harassment, intimidation or bullying. Include any gesture any relevant written, verbal or physical act(s), or any electronic communication.
Your answer
Location of alleged HIB incident. Please pecify/describe location in detail below
Your answer
Please describe the location selected above. *
Your answer
Was someone supervising when the incident occurred?
Please name the individual who was supervising.
Your answer
List below any person who you know or have reason to believe may have relevant information and indicate if student, parent, staff member or other.
Your answer
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