Anonymous Bullying Reporting Form

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

If you have information regarding bullying and would like to report this information anonymously, please fill out the following form to the best of your knowledge. (For the purpose of this form, bullying encompasses bullying, harassment, and discrimination.)

Victim's Name (Last, First, Middle) *

Victim's Sex

Female

Male

Prefer not to say

Other:

Clear selection

Victim's Grade

Victim's Age

Accused's Name (Last, First Middle)

Accused's Sex

Female

Male

Prefer not to say

Other:

Clear selection

Accused's Grade

Accused's Age

School

Principal

Today's Date

YYYY

Where did the incident occur?

When did the incident occur (date and time)?

Please describe, in as much detail as possible, what happened:

Do you know any of the witnesses involved? If so, please provide as much details as possible about these people:

List evidence, if any (for example letters, photos, links, etc.)

Acknowledgments *

I understand if a student is in IMMEDIATE danger, I should contact their home school, the police, or the Palo Verde Unified School District immediately. This report will be followed up on within 2 school/working days.

Required

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Palo Verde Unified School District. Report Abuse

Forms