Malone Middle School Bullying & Harassment Anonymous Incident Report
If you have any information regarding bullying/harassment and would like to report this information anonymously, please fill out the following form to the best of your ability and click submit.  Please note:  Making false allegations, providing discriminatory statements and making defamatory statements is prohibited and engaging in such activity will be reported to the appropriate authorities.

If you fear that a student is in immediate danger, please call the Malone Village Police Department at 483-2424, the New York State Police at 483-5000, or 911.
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Person making the report: [OPTIONAL]
Contact information: [OPTIONAL]
Target/victim's name (first and last): *
Target's grade: *
Alleged bully's name (first and last): *
Alleged bully's grade: *
Name of witness #1:
Name of witness #2:
Date of incident: *
Time of incident: *
Frequency of incidents: *
How often have you witnessed this type of behavior?
Where did the incident happen? *
Which of the following best describes what happened? *
Describe what happened: *
If witnesses were involved, describe their role in the incident: *
List any evidence available of the bullying/harassment (letters, texts, posts, photos, etc.): *
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