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Bully Report Form - Kermit Elementary School
(Information will be submitted directly to your campus counselor and will be kept confidential, except as needed to investigate and/or reprimand offenders.)
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* Indicates required question
Your First Name
Your answer
Your Last Name
Your answer
Your Grade
*
Your answer
Email Address (if you have one)
Your answer
Your Address
Your answer
Your Phone Number
Your answer
Who is being a bully? List specific names or description if you do not know names:
*
Your answer
Where is the bullying taking place? Check all that apply.
*
On the School Bus
Outside in the School Yard
Inside School Hallways
Inside Bathroom Areas
In the Classroom
In the Cafeteria
In the Gym or Locker Room
By Telephone or Text Message
Through Facebook, SnapChat, Twitter, or other Social Media
Other:
Required
Describe what is happening:
*
Your answer
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