Student Bullying Report Form

Please fill out the necessary fields. Respond only to questions that you feel comfortable answering and are able to accurately answer. You may choose to include your name at the end of the form or may submit it anonymously. Please note that the district's ability to investigate an anonymous complaint may be limited, and the District prohibits retaliation against anyone who files a bullying report.
When did it happen?
Where did it happen?
Did anyone else witness the bullying (if yes, please list)?
Were you or others physically hurt (please explain)?
Was there damage to anyone's personal property?
Have you missed or the victim missed any school or made any changes to your daily routine as a result of the incidents(s)?
Have you told anyone about the bullying? (you may check more than one)
Have you previously filed a bullying report (this information is used to determine if retaliation is occurring)?
Send this form to the following: *