Does this pertain to the elementary school (P-6) or high school (7-12). *
Date of Incident or Issue *
When did it happen?
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Location of Incident *
Where did it happen?
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Name of Student who you are reporting *
Enter first and last name
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Person(s) who was affected by this (if applicable) *
Were you the victim or was it some one else? Please enter first and last name.
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Did this happen during school hours or during a school sponsored event? *
Obligatoire
Did a school staff member witness?
Please list adult name.
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Incident Details *
Describe what happened....
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THE FOLLOWING QUESTIONS ARE SPECIFIC TO BULLYING: If you are reporting a bullying issue please complete the rest of this form. What type of bullying would you consider this to be?
Choose all that apply
Has this person bullied more than 2 - 3 times in the past 2 weeks?
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