Milton Public Schools - Alleged Incident Reporting Form (Cunningham)
Please submit this form to report an alleged incident that occurred involving a Milton Public Schools student.  This form may be used for reporting bullying or retaliation. The Principal/Superintendent or his/her designee will investigate all reports of bullying and retaliation and will take prompt action to end the conduct and restore the target's sense of safety. For more information, please refer to the MPS Bullying Prevention and Intervention Plan and Bullying Prevention Policy, available at all schools and on the MPS website. You can choose to file this report anonymously. However, please be advised that no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.
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1. What are you reporting? I am reporting... *
2. What is the primary school association for this incident? This is the school(s) where the alleged AGGRESSOR(S) attends.  The alleged "AGGRESSOR" is the person being accused of bullying or retaliation. Check all that apply. *
Required
3. Are you the TARGET of the incident or the person reporting it? The "TARGET" is the person on the receiving end of the alleged bullying or retaliation. *
4. YOU are reporting as a: *
5. What was the date of the incident? (Choose one key date if the incident spanned multiple times.) *
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6. Did the incident occur on school grounds? *
7a. Where did the incident occur? *
7b. Please briefly describe the location of the incident. *
8. Name of the alleged "AGGRESSOR(S)."  
Enter the name(s) of the person(s) who is doing the bullying or harassing. If you don't know, please write "Unknown".
 *
9. Name of the alleged "TARGET(S)."  
The "TARGET" is the person on the receiving end of the alleged bullying or retaliation. If you don't know, please write "Unknown".
 *
10. If known, please list other individuals involved in this incident by names and roles (witness, bystander, staff, etc).
11. Describe the event. Enter the details of the report below. Please submit as much information as possible. Be sure to include date(s) if known. 

If you do not know the names of the persons involved, then please describe them as best you can with any characteristics that may help with identification. Please include the location of the incident if known. If you feel that there is immediate danger for anyone involved, please call 911 immediately.
 *
Optional Information
The following information is 100% optional. If you want to include your contact information, then you may do so below. A representative from school may contact you about this incident. We encourage everyone in the district to report any incident that can be harmful to another person or to the community at large.
Your First and Last name
Your phone number
Your email
Would you like an administrator to contact you regarding this report?
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