3. Your telephone number and/or email address (optional)
Your answer
4. Are you a: *
5. Name of student being bullied. *
Your answer
6. Name of alleged offender.
Your answer
7. Is the alleged offender older or younger than the person being bullied? *
8. Date of the incident *
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9. Name of any other person that could have seen the incident and could provide more information.
Your answer
10. Where did the incident occur (check all that apply) *
Required
11. Check the statement that BEST describes what happened: *
Required
12. Does this meet the definition of bullying? Definition: Intentionally aggressive behavior, repeated over time and involves an imbalance of power. If so, provide more information. *
Your answer
13. To your knowledge, has this been reported before? *
14. To your knowledge, has this type of incident happened with this student before? *
15. Is there any additional information that you would like to provide? *
Your answer
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