TL Incident Report Form 2023-24
You may use this form to report  bullying, hate speech, sexual harassment, or other inappropriate behavior.  You may fill this out for yourself or for someone else if you are being an ally for.

This will be kept confidential. The only people who view this report are the school administrators and counselor. You will not need to confront or speak with the person you are reporting on unless you choose to do so. 
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What is today's date?
Your First Name *
Remember, this will be kept confidential and used only by school administrators if follow up is needed (see above).
Your Last Name *
What grade are you in? *
What is the name of the student being targeted or hurt by the behavior? *
(could be you or the person you're being an ally for)
What grade is the student being targeted in? *
What is the name(s) of the student(s) who was bullying or using inappropriate behavior? *
Please use their first and last name if possible.  If you don't know, you can write "I don't know" or include a description of them.
What grade is that student in? *
What was the date this happened?
If this occurred during class time, which teacher's class was it in?
About how often is the behavior happening?
How much is the behavior affecting you?
Is there a specific teacher, administrator or staff member whom you would feel most comfortable talking to about this?
If so, write his or her name here.
Please describe what has been happening to you or the person you are submitting this for. We take bullying and harassment seriously, and we appreciate your courage and honesty.
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