Report Mistreatment
If you see someone being mistreated, please do what you can to stop it, as a student, you have more power than you think to influence your friends!  If you need help please fill out this form.
This information will be sent to your counselor. They will be the only one who sees  your name.  Your name will never be shared with any other students.  You do NOT have to give your name, but it is very helpful in case we need more details from you. 
Sign in to Google to save your progress. Learn more
Your First Name
Your Last Name
Grade *
Name(s) of students involved-tell us as many as you know. Please also list anyone else who might have seen it happen.
Where did the incident happen? *
Required
Describe the incident. If it was on a bus or in a classroom please provide bus number and morning/afternoon ride, if it was in a classroom/bathroom please say which one.  Any details you can provide will be helpful. *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Loudoun County Public Schools. Report Abuse