Wednesday, October 1, 2014

To report by written complaint please see documents below:

Reporting A Bully Forms

To report online: Please complete the form below to the best of your ability.  All questions with a red * asterik must be answered before submission in order to be able to address the problem; the victim and the bully must be identified.

THIS INFORMATION IS ADDRESSED BY THE ADMINISTRATORS OF THE DISTRICT AND IS STRICTLY CONFIDENTIAL!



Items denoted with a red asterisk * are required.
Date
 
Click to View Date Picker
Time
 
(hh:mm am/pm)
 * 1. Please indicate where the incident took place?
 
 * 2. Main bully's first and last name or other information that will help us identify him/her.
 
 * 3. Was there more than one student bullying, if so list the first and last name or other information that will help us identify them.
 
 * 4. Victims first and last name or other information that will help us identify him/her.
 
 * 5. Date and time of the bullying incident. Please use the following format: Date - mm/dd/yyyy Time - hh:mm am/pm
 
 * 6. Do you know the main bully?
 


7. Do you know the second bully?
 


 * 8. Do you know the victim?
 



 * 9. Where did this incident occur?
 
 * 10. Describe in detail what the bully did to the victim.
 
 * 11. Gender of the bully?
 


12. Gender of the second bully?
 


 * 13. Gender of the victim?
 


 * 14. Grade of the bully?
 
15. Grade of the second bully?
 
 * 16. Grade of the victim?
 
 * 17. Have you told any teacher, school administrator, parent or other adult about this incident?
 


18. If you answered yes, please indicate who you spoke with and when?
 
19. Please list names of witnesses or bystanders who might also have seen this happen.
 
 * 20. Your first and last name?
 
 * 21. Your grade?
 
 * 22. Your phone number and/or email address?