RMS Student Report
Your Name:
*
First Name
Last Name
Your Grade:
*
Please Select
7th Grade
8th Grade
Class Hour that it happened:
*
Please Select
Breakfast
1st Hour
2nd Hour
3rd Hour
4th Hour
5th Hour
6th Hour
7th Hour
A Lunch
B Lunch
C Lunch
D Lunch
Please check the following that apply to this situation:
*
Injury
Teasing/Bullying
Verbal Argument
Gossip/Rumors
Fighting/Physical Contact/Recording a Fight
Social Media
Suspected Drug/Alcohol Use
Smoking/Vaping
Other
Were you directly involved?
*
Please Select
Yes
No
A witness
Has this happened more than once?
*
Please Select
Yes
No
Name of person you are reporting:
*
First Name
Last Name
Do you choose to be around this person?
*
Please Select
Yes
No
Have you told any other adults? Check all that apply:
*
Teacher
Counselor
Administrator
Parent
Friend
No
Please explain what happened. Be detailed about the event, time it took place, location, etc.
*
Were there any witnesses that could provide additional information?
*
Please Select
No
Yes - please list names below.
Please list the names of all the students who were involved and list witnesses:
*
Submit
Should be Empty: