FMS Bullying Report Form 2023-2024
All responses will be sent to the principals and school counseling office.  You are not required to include names, but knowing the name(s) of the people involved helps us investigate as thoroughly as possible. Therefore, please include this information if you feel comfortable doing so.
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Email *
Are you able to check all 4 of these boxes regarding the bullying situation? If you cannot check all 4 of these boxes, then filling out a Request to See the Counselor Form may be a good idea. *
Required
Date of Event *
MM
/
DD
/
YYYY
Location of Incident *
Use "Other" if you have an exact location.
Time of Event *
If you do not know the exact time of the incident, pick an approximate time
Time
:
I am a:
Clear selection
If you are a student, select your current grade. *
First and Last Name
Witnesses or Bystanders:
Who else saw this happen? If no one else observed, it is okay to leave this blank.
Name(s) of student(s) being bullied or targeted: *
Grade AND/OR Class
Name(s) of student(s) bullying: *
Describe the Incident: *
Describe what happened. Include the names of people involved, if you know them. Also include what each person said and did.
How many times has the incident happened?
Have you told anyone about this before?
If so, who?
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