Please provide the first and last name(s) of the person/people who was/were bullied, harassed, intimidated, or harmed.
If possible, please tell us the first and last name(s) of the person/people bullying, harassing, intimidating or causing harm. Please note if they were students, staff, or someone else.
Describe what happened. Please give as much information as you can, including the names of any people who saw what happened. Please also describe any specific safety concerns you may have.
Do you think the incident was based on race, color, national origin, ethnicity, gender, gender identity, gender expression, sexual orientation, disability, age, or other protected class?
Where did this incident occur?
When did this incident occur?
How many times has this incident, or a similar incident, occurred? Please describe.
Did any incident involve cyberbullying? If so, on which platform did it occur?
If possible, please provide the screen name, website, or other information about the cyberbullying.
Have you reported the incident(s) to any adults? If so, whom?
Tell us who you are
(Select one or more)
How can we contact you?
To receive a personalized response, please enter your name and at least one method of contact. If you leave this section blank, then we will not be able to respond to your message. If you would like to receive a response but keep your identity hidden from us, enter your email address and select 'Hide your contact information from the district.'

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