The Bully Report
Use this form to report an incident of bullying, harassment, or intimidation. Please provide as much detail as possible. You may choose to include your name, or make the report anonymously.
1.
School Name
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2.
Location of incident
*
3.
Date of incident: mm/dd/yy
4.
Name of person bullying
*
5.
Name of person being bullied
*
6.
Optional: Contact information of person reporting. Please include name, email or phone number.
7.
List name & title of any teacher, school administrator, law enforcement official, SRO, or parent/guardian you have reported this incident to.
*
8.
Describe what happened in as much detail as possible.
*