Bullying Incident Report Form
If you have been the target of bullying or have witnessed the bullying of a District student, complete this form, which will be submitted to the building principal. Complaints against building principals should be submitted to the Superintendent.  Complaints against the Superintendent should be submitted to the Board of Education.  Reports of bullying will be investigated and disciplinary action will be taken as warranted.
Sign in to Google to save your progress. Learn more
Bullying frequently involves repeated behavior.  If you have witnessed or have knowledge of more than one incident, please provide information on all incidents.  Please feel free to complete multiple forms if necessary to report all related incidents.
Name of reporter, person filing the report (If you prefer to remain anonymous, leave this blank.  The district will investigate all allegation of bullying, but it is more difficult to follow up on anonymous reports.)
Date Filed
MM
/
DD
/
YYYY
Address, Phone Number, & Email (If you prefer to remain anonymous, leave this blank.  The district will investigate all allegation of bullying, but it is more difficult to follow up on anonymous reports.)
Relationship to the student being bullied (parent/guardian, fellow student, community member, etc.)
Did you witness this incident?
Clear selection
If no, provide the specific information as to how you found out about this incident.
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Ralls County R-II School District. Report Abuse