Bullying: REPORT NOW

BULLYING REPORTING FORM

Policy on Bullying

Name of Victim  Victim's Campus  Grade  

Date  Location 

Name of Alleged Bully 

Grade of Alleged Bully 

What Happend 

Did anybody else witness what happened?

If Yes, who?  

How long has this been happening?  Has this been reported before? 

HAS ANYONE BEEN NOTIFIED?  

If Yes, who?

Parent Name 

Teacher/Counselor Name 

Principal/Asst. Principal Name 

Others 

Your Name (Optional) 

Is it okay someone contacts you?  

If yes, please provide email or phone number 



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