Bullying Form

Name of Person Reporting This Incident
Student's Name
Parent's Name
Date / Time of incident
Enter the day or approximate day the incident took place.
Select from the dropdown menu
Did this incident happen to you?*
Location the incident took place:*
Rude, Mean, Conflict or Bullying?*
Please select the option that best describes the incident.
Is it one-sided or two-sided?*
Did it happen more than once?
Do you think they did it on purpose?*
Were they told to stop?*
This complaint is based upon my honest belief that the information I have provided in this complaint is true, correct, and complete to the best of my knowledge.*
I understand that the complaint will be investigated and that, although the administration will protect the confidentiality of individuals providing information as best as possible, confidentiality of this complaint cannot be guaranteed.*
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It always seems impossible until it's done.

— Nelson Mandela

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