MHS Bullying Report Form
Please report any bullying incidents you feel may be going on at school. All reports will be investigated by the administration.
Email address *
Your name *
Your answer
Location of Bullying *
Where did you experience or witness bullying take place?
Type of Bullying *
What did you experience or witness?
If the above response was cyber bullying, please indicate all the sources. i.g. text message, e-mail, social media platform, etc. If social media was used, please identify the platform(s) used. i.g. Instagram, Facebook, Twitter, Snapchat, etc.
Your answer
Your Role in the Bullying *
Please name target(s). *
Who was being bullied?
Your answer
Please name the bully/bullies in this incident. *
Your answer
Please list any bystanders that witnessed the incident. *
Your answer
Please describe what happened using as much detail as you can. *
Your answer
Is this your first report of this incident to an adult? *
If you reported the incident to an adult, please name that person.
Your answer
Never submit passwords through Google Forms.
This form was created inside of Meade Public Schools USD 226. Report Abuse - Terms of Service