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Stewartville High School Bully/Harassment Form
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Email
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Record my email address with my response
Submitted by
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We will try to identify any student whose health or safety is in danger.
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Name of person being bullied
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Your answer
Grade Level
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9
10
11
12
Please describe what has happened.
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Specific dates, locations, and exact quotes are most helpful.
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Please list any witnesses to this incident.
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Your answer
Please check others that are aware of this incident
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Parents
School Staff
Friends
Other:
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When would you like to discuss this matter?
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All discussions will be kept confidential.
Before School
Homeroom
During Lunch
After Lunch
Other:
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A copy of your responses will be emailed to .
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