Bully Reporting Form

Bully Reporting Form

Striving for Antibullying!

If you feel unsafe or know someone who feels unsafe report it here. 

You don't have to tell us your name, we just want to make sure you stay safe!

Date it happened?

Time it happened?

How many times
has this happened? 

Have you reported
this to an adult?

 Yes

 No

 

Did you report this to a teacher, counselor or other school staff member before filling out this form? 

 Yes

 No

 

Which school or location did this occur?  

Where did it happen?  

Who is bullying or harming you? (Include first & last name and grade if known) 

Who is the person being bullied or harmed? (Include first & last name and grade if known) 

Describe what happened with as many details as you can, include the names of others who saw this happen. 

Who are you?  

What is your name (Optional, you don't have to tell us your name).

If you'd like us to contact you by email, please provide your email address

If you would like us to contact you by phone, please enter it below.

Once you submit this report we will investigate this further and contact you if you have provided an email or phone number.

Thank you for taking time to share this important information as this helps us establish an anti-bullying environment for everyone.



Security Measure
IP

Anonymous submissions are welcome.
Inappropriate submissions will be investigated.