Report Bullying Now
Report Bullying and/or Harassment
You can choose to remain anonymous.
1.
Have you reported this incident to anyone in authority? This could include a teacher, principal, or any other staff member at the school.
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Have you reported this incident to anyone in authority? This could include a teacher, principal, or any other staff member at the school.
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Yes
No
2.
If you answered "Yes," who did you tell?
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3.
Name of person you believe is being bullied or harassed. (First and last name if known.)
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4.
Which school?
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--Please Select--
Belmont Elementary
Clear Creek Elementary
Horizon Elementary
Mize Elementary
Prairie Ridge Elementary
Riverview Elementary
Starside Elementary
Lexington Trails Middle School
Mill Creek Middle School
Monticello Trails Middle School
De Soto High School
Mill Valley High School
5.
Where, exactly, did the bullying take place? Be as specific as possible regarding the incident(s).
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6.
What happened? (Check all that may apply.)
Physical: hitting, kicking, or other physical aggression
Verbal: teasing, name-calling, put-downs, or other behavior that would hurt others' feelings or make them feel bad
Exclusion: starting rumors, telling others not to be friends with someone, or other actions that would cause someone to be without friends
Cyber bullying: using a computer, mobile phone, or other electronic device to engage in any previously mentioned bullying
Other, please specify
7.
Name of the alleged bully
8.
Please describe the incident.
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9.
Date of the incident?
10.
Did you witness the event?
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--Please Select--
Yes
No
11.
Please list others who may have witnessed the incident.
12.
Your name (optional)
13.
I am...
--None--
the person being bullied
a student
a parent / guardian
a school employee
a friend
14.
Additional comments