Bully Reporting Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

Mountain View Elementary School

Bully Protocol

Mr. Patrick McGarry, Principal

Anonymous Bullying Reporting Form

This form is directly submitted to the Administrative Office of the Mountain View Elementary School. All information is strictly confidential.

Person being bullied

Bully Name

Your name (Optional)

I am a :

Student

Parent/Guardian

Community Member

Staff Member

Person being bullied

Friend

Clear selection

Date

YYYY

Type of Bullying

Physical - Hitting, kicking, or other physical aggression

Verbal - Teasing, name-calling, put-downs, or other behavior that would hurt others' feelings

Emotional/Exclusion - Starting rumors, telling other not to be friends with someone

Cyber Bullying - Using an electronic medium to engage in any previously mentioned bullying

Clear selection

Description of Events

Did you witness the bullying

Yes

Clear selection

List other witnesses (if available)

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Mountain View School District. Report Abuse