Incident/Bullying Report-Anonymous

Where did the incident occur? If at school, which campus?*

Answer required for "Where did the incident occur? If at school, which campus?"

Date of Incident?*

Answer required for "Date of Incident?"

What type of Incident?*

Answer required for "What type of Incident?"

Bullying

Threat

Trespassing

Vandalism

Drugs

Personal Crisis

Safety Risk

Weapons

Other:

If Bullying, what type?

Answer required for "If Bullying, what type?"

Verbal

Sexual Harassment

Physical

Cyber-bullying

Other:

Who was bullied? (Name and Grade)

Answer required for "Who was bullied? (Name and Grade)"

Who did the bullying? (Name and Grade)

Answer required for "Who did the bullying? (Name and Grade)"

Who is reporting this information*

Answer required for "Who is reporting this information"

Parent/Guardian

Teacher

Staff Member

Student

Administrator

Volunteer

Board Member

Community Member

Other:

Did you witness the incident/bullying firsthand?*

Answer required for "Did you witness the incident/bullying firsthand?"

Yes

Were there any other witnesses? If so, please list their names here:

Answer required for "Were there any other witnesses? If so, please list their names here:"

Describe what happened. Give as much information as you can.*

Answer required for "Describe what happened. Give as much information as you can."

Any other information that you would like to share

Answer required for "Any other information that you would like to share"

All personal information is optional and confidential. Anonymous reports are accepted; however, they must provide sufficient evidence to justify the commencement of an investigation. Formal disciplinary action may not be based on anonymous complaint.

Your name:

Answer required for "Your name: "

Email:

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Phone Number:

Answer required for "Phone Number:"

Please fix the highlighted areas below before submitting.

Incident/Bullying Report-Anonymous