6th Grade Bully Reporting Form
This form is NOT to be completed if someone is threatening to fight/hurt you, or has assaulted you (i.e., hitting, pushing, kicking, punching). If this is the case, you must complete a BLUE Incident Report form in Strong Middle School's main office and turn it in to Ms. Kirk (Assistant Principal) or  Mr. Howard   (Principal) right away during school hours!  

These Bully Buster Complaint forms are meant for verbal/cyber bullying or situations that have repeatedly made you feel uncomfortable/offended at school. The forms will only be checked during school business hours: 7:45 a.m. - 3:00 p.m. If it is after school hours and your situation involves physical assault please let an adult know ASAP (Example: parent/guardian, police). If you are being bullied and you are having suicidal feelings PLEASE IMMEDIATELY let a trustworthy adult know or call the National Suicide Prevention Hotline: 1-800-273-8255
Sign in to Google to save your progress. Learn more
DID YOU VERBALLY TELL THE PESON YOU ARE REPORTING TO STOP? *
When did the bullying incident take place? *
MM
/
DD
/
YYYY
Your name (optional)
Your Grade
Clear selection
Who was bullied? *
Bully's First and Last Name? *
Bully's Grade Level *
Other possible witnesses
Where did the bullying incident happen? *
What happened? *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Melvindale - Northern Allen Park Public Schools. Report Abuse