Report Bullying

Name of Reporter/Person Filing the Report:
(Note: Reports may be made anonymously, but no disciplinary action will be taken against an alleged aggressor solely on the basis of an anonymous report.)

Your contact information /telephone number:

If student, select your grade:

Information about the Incident

Name of Target (of behavior):

Name of Aggressor (Person who engaged in the behavior):

Date(s) of Incident(s):

Time When Incident(s) Occurred:

Location of Incident(s) (Be as specific as possible):

Witnesses (List people who saw the incident or have information about it):

Witness 1
Name

Witness 2
Name

Witness 3
Name

Describe the details of the incident (including names of people involved, what occurred, and what each person did and said , including specific words used).