Incident/Bullying Report-Anonymous

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

Answer Required

Date of Incident?*

Answer Required

What type of Incident?*

Answer Required

Bullying

Threat

Trespassing

Vandalism

Drugs

Personal Crisis

Safety Risk

Weapons

Other:

If Bullying, what type?

Answer Required

Verbal

Sexual Harassment

Physical

Cyber-bullying

Other:

Who was bullied? (Name and Grade)

Answer Required

Who did the bullying? (Name and Grade)

Answer Required

Who is reporting this information*

Answer Required

Parent/Guardian

Teacher

Staff Member

Student

Administrator

Volunteer

Board Member

Community Member

Other:

Did you witness the incident/bullying firsthand?*

Answer Required

Yes

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

Answer Required

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

Answer Required

Any other information that you would like to share

Answer Required

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

Email:

Answer Required

Phone Number:

Answer Required

Please fix the highlighted areas below before submitting.

Incident/Bullying Report-Anonymous