Form
Do you feel that you as a student at Infant of Prague Catholic School have been the victim of bullying?
Yes
No
Do you feel that a student other than yourself has been the victim of bullying?
Yes
No
Name(s) of the student(s) alleged to have been bullied.
Were threats made during the incident(s)?
Yes, verbal threats
Yes, physical threats
Yes, text or online threats
No
Other
Do you have any evidence to submit regarding the alleged incident?
Yes
No
Names of witnesses to alleged bullying, if any?
Please provide a brief description of the incident(s), including locations(s), date(s), and times(s) if possible.
Please provide the names and grade levels, if known, of the alleged bully or bullies.
Person submitting the form. If you would like to remain anonymous, please leave blank. (If you wish to be contacted, please include your contact information)
Submit
Should be Empty: