Bethel Regional High School         Bullying/Harassment                                       Reporting Form
Bullying and harassment are violations of school district policies, rules, and regulations and, in some cases, may also be a violation of criminal or other laws. Thus bullying or harassment of students is not tolerated by Bethel Regional High School and the Lower Kuskokwim School District. For more information regarding this policy, please refer to the student handbook located on our school website.
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First Name of Person Reporting (Optional)
Last Name of Person Reporting (Optional)
How Can We Contact You if Needed? (Optional)                         Phone Number or Email Address
Age of Person Reporting: *
First Name of Victim *
Last Name of Victim *
First Name of Alleged Harasser or Bully *
Last Name of Alleged Harasser or Bully *
Date of Incident *
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Approximate Location of Incident *
Required
Nature of Discrimination or Harassment *
Required
Type of Harassment *
Required
Description of the Incident:                                           Please provide who, where, when, what happened. *
Name of Witnesses (if any):
Please Describe Any other Information:                                              Reference of text messages, videos, pictures, posts...   Please have them available to share....
How often has this type of incident occurred: *
Was this issue previously reported?                            Please check the appropriate box and other if it was previously reported to and name the person. *
Required
I agree that all of the information is accurate and true to the best of my knowledge. I understand that if I make a false report to get someone in trouble for something they did not do, I could face possible consequences.
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