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Farmersville ISD Bullying, Harassment, or Intimidation Reporting Form
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* Indicates required question
Campus / Department
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Tatum
Farmersville Intermediate
Farmersville Junior High
Farmersville High School
Other:
Person Reporting Alleged Incident
Your answer
Phone Number for Person Reporting Alleged Incident
Your answer
Email for Person Reporting Alleged Incident
Your answer
Person Reporting Incident Role
Choose
Student
Parent/guardian of a student
Close adult relative of a student
School staff
Bystander
Alleged Student Victim(s)
*
Your answer
Alleged Witnesses (if known)
*
Your answer
Alleged Offenders (if known)
*
Your answer
On what date did the alleged incident happen?
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MM
/
DD
/
YYYY
Additional details regarding dates:
Your answer
Where did the alleged incident happen (choose all that apply)?
*
On school property
At a school-sponsored activity or event off school property
On a school bus
On the way to/from school
Online (sent on or off school property)
Other:
Required
Describe the alleged incident(s), including what the alleged offender(s) said or did.
*
Your answer
In your opinion, why did alleged incident occur?
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Your answer
Did a physical injury result from this alleged incident?
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Yes
No
Was the student victim absent from school as a result of the alleged incident?
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Yes
No
Additional information/comments.
Your answer
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