Report Bullying Form

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If you would like to report a bullying incident, please fill out the following form. All information will be kept confidential and will be sent directly to the superintendent's office when you click "submit" at the bottom of this form.

All information submitted in this form will be sent to the superintendent, Dr. Troy Pitsch.

Updated January 2023

Email *

Person submitting form name (first & last name) *

Person submitting form email *

Description: Please tell us the who, what, when, and where of the bullying incident.

Would you like a follow up visit with the counselor or administrator?

If you choose this answer you MUST include a phone number to be reached.

Yes

Clear selection

Phone Number (if want a follow up visit)

Submit

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