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 *
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 Role in the Bullying *
Please name target(s). *
Who was being bullied?
Please name the bully/bullies in this incident. *
Please list any bystanders that witnessed the incident. *
Please describe what happened using as much detail as you can. *
Is this your first report of this incident to an adult? *
If you reported the incident to an adult, please name that person.
Never submit passwords through Google Forms.
This form was created inside of Meade Public Schools USD 226. Report Abuse