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Bullying Form
17 Questions
1) What type of incident was this?
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2) Email Address
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3) Describe what happened/what is happening:
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4) When did it happen?
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5) Date & Time
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APR
2024
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6) Where did it happen?
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7) Who was committing the bullying (if you don't know the bully's name, describe him/her)?
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8) Who was the victim of the bullying (if you don't know his/her name, describe him/her)?
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9) Did anyone else witness the bullying (if yes, please list)?
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10) Were you or others physically hurt (please explain)?
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11) Was there damage to anyone's personal property?
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Yes
No
Unsure
12) Have you or the victim missed any school or made any changes to your daily routine as a result of the incident(s)?
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Yes
No
Unsure
13) Have you told anyone about the bullying?
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14) Have you previously filed a bullying report (this information is used to determine if retaliation is occuring)?
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Yes
No
15) Your name (Optional):
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16) Your grade and age (Optional):
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17) How can we contact you?
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