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Pacific Drive: Report Bullying Anonymously Form
Purpose: To give Pacific Drive parents/guardians and students the ability to report bullying anonymously.
Propósito: Ofrecer a los padres o guardianes y a los alumnos de Pacific Drive la posibilidad de reportar el acoso de forma anónima.
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* Indicates required question
1. Who was hurt or injured?
*
Quién está herido?
Your answer
2. Your name (OPTIONAL)
Su nombre (opcional)
Your answer
3. Relationship to the person who was hurt
*
Relación a la persona que fue herida
Choose
Parent/ Padre
Student/ Estudiante
Staff/ Personal
None-/ Ninguna
Other/Otros
4. Your Phone Number and/or Email (optional)
Su número de teléfono o correo electrónico (opcional)
Your answer
5. Accused Bully Name(s) OR a description of bully (if name is unknown)
*
Nombre(s) del Acusado O descripción del Acosador (si no se conoce el nombre)
Your answer
6. Location: where did it happen?
*
Localización: ¿dónde ocurrió?
Your answer
7. Describe what happened in as much detail as possible
*
Describe lo que ocurrió con el mayor detalle posible
Your answer
8. When did it happen: date of the incident?
*
¿Cuándo ocurrió: fecha del incidente?
MM
/
DD
/
YYYY
9. Time of incident?
*
¿Hora del incidente?
Time
:
AM
PM
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