JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
KMS Reporting Form
This form is a way for you to report bullying and harassment. Please know that you can also report directly to the office or to a staff member who you feel comfortable reporting to.
Instructions: Complete by responding to the questions that you feel comfortable answering and are able to accurately answer. Please note that the District prohibits retaliation against anyone who submits a report. If you do not include your name in this report the District's ability to investigate an anonymous complaint and subsequent actions may be limited.
Sign in to Google
to save your progress.
Learn more
Describe what happened/what is happening.
Your answer
When did it happen?
MM
/
DD
/
YYYY
Time
:
AM
PM
Where did it happen?
Your answer
Who was involved?
Your answer
Were there other witnesses?
If so, please list(optional)
Your answer
Were you or others hurt or frightened?
Please explain.
Your answer
Have you or the victim missed any school or made any changes to daily routine as a result of the incident(s)?
Please explain.
Your answer
Who have you told about this?
Your answer
Person making the report:
Optional
Your answer
Your grade and age:
Optional
Your answer
If you are not a student, how can we contact you?
Phone, E-Mail, Other:
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Kalama School District.
Report Abuse
Forms
