Bullying Report Form
Investigation of Allegations of Bullying/Cyber-Bullying/Harassment
It is my understanding that all statements made in the complaint are true. Any intentional false statement of face will subject me to appropriate discipline or other action.
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What is your First Name?
What is your Last Name?
What grade are you in?
What is your birth date?
Which school do you attend?
Middletown High School
Joseph H. Gaudet Middle School
Gaudet Learning Academy
Forest Avenue Elementary
What was the date when the incidence of bullying occurred?
At about what time did the incidence of bullying occur?
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This form was created inside of Middletown Public Schools.