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Bullying Online Reporting Form
Sapulpa Public Schools strictly prohibits any form of bullying and encourages anyone who has been subject to or witnessed bullying to use this form to report the alleged incident. You may remain anonymous however, it is often difficult to fully investigate claims which are made anonymously.
Bullying reports will be checked during normal school hours. Reports that are filed outside of the typical school day will be reviewed during the next school day. If this is an emergency or life-threatening situation please call 911.
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* Indicates required question
Name (optional)
Your answer
Who are you? (Please check only one)
*
Student
Parent
Concerned citizen
Required
How may we contact you to follow-up on your incident report? Please list your contact information (if you wish to remain anonymous write N/A).
*
Your answer
What type of bullying are you reporting? Please consult Policy 540.1.7 for clarification of the types.
*
Physical bullying
Emotional bullying
Social bullying
Sexual bullying
Threatening behavior
Electronic communication (cyber bullying)
Required
Are you the victim or a witness?
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Victim
Witness
Other:
If you are not the victim, please list the victim's name and as much information about that person as you can, i.e. grade, gender, race, nickname, etc.
Your answer
What was the date of the incident?
*
MM
/
DD
/
YYYY
What was the time of the incident?
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Time
:
AM
PM
Where did the bullying take place?
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Freedom Elementary
Holmes Park Elementary
Jefferson Height Elementary
Liberty Elementary STEM Academy
Sapulpa Middle School
Bartlett Academy
Sapulpa Junior High School
Sapulpa High School
Other:
Required
List the name(s) of the alleged offender. Include grade, gender, race.
*
Your answer
List the witnesses including students, faculty, and staff. If no one witnessed the incident please write NONE.
*
Your answer
Please describe in detail what happened?
*
Your answer
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