JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Bullying Alert
Hopewell-Loudon Schools is committed to providing you with a safe learning environment. If you are a victim of, or witness to bullying in any form please report it here. You can remain anonymous if you prefer. It would be helpful if you gave us your name in order to provide you direct assistance. If alleged harassment occurred more than once submit another complaint......
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Optional: Your name
Your name would help us to better assist you.
Your answer
Date of Alleged Harassment
*
example: Thursday 9/6/2012
MM
/
DD
/
YYYY
Location of Alleged Harassment
*
Please give a description of location where Bullying occurred.
Your answer
Description of the incident(s)
*
Please describe in as much detail as possible information pertaining to incident.
Your answer
Optional: Please add names of any other persons who may have witnessed harassment below.
Your answer
What type of harassment is this?
*
Check all that apply
Physical contact
Verbal Abuse
Social Media, Such as Facebook, Twitter or Google Plus
Other:
Required
If this was done on Social media (Facebook, Twitter or Google Plus) please copy and paste the link into the box below.
Your answer
YOU ARE DONE PLEASE SUBMIT YOUR COMPLAINT BELOW: ALL INFORMATION BELOW IS COMPLETED BY INVESTIGATOR:
Date Investigative action taken: example, 9/6/2012
Your answer
Administrator Name
Your answer
Investigative Action Taken
Your answer
Resolution
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Hopewell-Loudon Schools.
Report Abuse
Forms
