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Burr Ridge Middle School Form to Report Bullying or Possible Threats to School Safety
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Email
Your answer
Phone Number
Your answer
I am a
*
Student
Parent or Guardian
Other:
Please describe the incident of bullying or possible threat to school safety. (Safety to student, staff or building)
*
Your answer
Date the incident occurred
*
MM
/
DD
/
YYYY
Time the incident occurred
*
Time
:
AM
PM
If you require an immediate response, please contact the police.
DuPage County Sheriff's Department
630-407-2400
Burr Ridge Police Department
630-323-8181
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