Newmarket Jr/Sr High School Bullying and Harassment Online Reporting Form

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This is a form to report alleged bullying and/or harassment. You can submit a report for yourself or an anonymous report for someone who is being bullied and/or harassed. This incident will be addressed by NJSHS administration within 24 hours.

Alleged Victim's First and Last Name *

Alleged Perpetrator(s) First and Last Name(s) *

Date of Alleged Incident *

YYYY

Who is reporting this incident? *

Friend/Student

Self-Referral

Staff

Parent/Guardian

Category of Bullying (please check all that apply) *

Physical

Verbal

Electronic

Other

N/A

Required

Category of Harassment (please check all that apply) *

Racial

Sexual

Gender

Physical Characteristics

Disability

Other

N/A

Required

Please provide a brief, detailed summary of incident. *

Name of person initiating this report. Please indicate "anonymous" if you do not want to provide your name. *

Submit

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