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Report Bullying Here
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* Indicates required question
Your name
Your answer
Name of person being bullied
*
Your answer
Are you the one being bullied?
*
Yes
No
Has the person doing the bullying (check all that apply)
*
told lies to others
caused physical touching or harm
verbally harassed
damaged or taken personal property
threatened or forced
excluded you or others from games, sports or other activities
made remarks about gender orientation
made racial remarks
made sexual remarks
Required
How often does the bullying occur?
*
daily
weekly
occasionally
Required
Where does the bullying occur?
*
classroom
hallways
dining hall
bathroom
bus
outdoors on school grounds
online/cyber via cellphone or Internet
Required
If online, through which websites?
Your answer
Please describe what is happening in as much detail as possible:
*
Your answer
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