ANONYMOUS Bullying Report Form


Are you being bullied, harassed, or picked on? Do you know someone else who may be?
You can use the form to ANONYMOUSLY report what is going on.


Who were the person(s) engaged in bullying?
Classes of person(s) engaged in bullying?
Who was being bullied?
Class of person being bullied?
What type of bullying?
Where did the incident take place?
What date/time did the incident take place?
Describe what happened with as many details as possible
Your Name? (OPTIONAL)
Your Class? (OPTIONAL)