Please note that no determination of bullying will be made solely on the basis of an anonymous report.
A student who knowingly makes a false accusation of bullying or retaliation will be subject to disciplinary action.

To anonymously report bullying please provide the following information:

Name of target of behavior:

Name of aggressor (person who engaged in the behavior):

Date(s) of the incident(s):

Time when incident(s) occurred:

Location of incident(s):

List of witnesses (anyone who saw the incident or have information about it):

Name:     Staff/Student/Other: Staff Student Other

If Other, please describe:

List of witnesses (anyone who saw the incident or have information about it):

Name:     Staff/Student/Other: Staff Student Other

If Other, please describe:

List of witnesses (anyone who saw the incident or have information about it):

Name:     Staff/Student/Other: Staff Student Other

If other is selected, please describe:

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

Please be sure to provide your contact information if not reporting anonymously. Thank you.

Name:     Student/Parent/Other: Student Parent Other

Phone Number: