Madison County School District Bullying/Harassment Reporting Form
Bullying and harassment are violations of school district policies, rules, and regulations and, in some cases, may also be a violation of criminal or other laws.  Thus bullying or harassment of students is not tolerated by Madison County Public Schools.  For more information regarding this policy, please refer to the Board Policies located on our district website.
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Which School Do you attend? *
Required
First Name of the person making the report:
 

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Last Name of the person making the report:
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Grade of the person making the report
First Name of victim (person that was bullied/harassed):
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Last Name of victim (person that was bullied/harassed) :
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First Name of alleged harasser or bully:
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Last Name of alleged harasser or bully:
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Date of incident:
Give the approximate date and time the incident occurred.
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MM
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Time
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Location of the incident:*
Give the approximate location of the incident.
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Required
Nature of Discrimination or Harassment:*
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Required
Type of Harassment:
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Required
Description of the incident:*
Provide a detailed description of what happened and/or what was said.
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Name of witnesses (if any):
Any other information:
Include reference to evidence you may have including text messages, posts, pictures...
Your answer

How often has this issue occurred?
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Was this issue previously reported?*
Please enter the name of who this issue was previously reported to in the Other Information field.
I agree that all of the information is accurate and true to the best of my knowledge:
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