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Central Bullying Report Form
If you think you or someone else is being bullied, please fill out the form to the best of your ability so we can address the situation. You can report this anonymously if that is more comfortable for you.
* Indicates required question
Email
*
Record my email address with my response
If you would like to share your name with us, please type your
first and last name
below.
Your answer
What is your
Student ID
number? (if you are choosing to give your name)
Your answer
What is
your grade
level?
*
7
8
What is the
grade level of the person
you are reporting?
*
7
8
unknown
Who is involved in the situation? (Please
list all people
involved with
first and last names
if possible, and explain who you think is being bullied)
*
Your answer
Please
describe
what has been happening.
*
Your answer
Where
has this been happening? (example: locker room, lunch area, to or from school, social media/online)
*
Your answer
Has it happened more than once?
*
Yes
No
How long has this been going on?
*
Your answer
When was the last time this happened?
*
MM
/
DD
/
YYYY
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