Report Bullying Incident
Please complete this form to the best of your knowledge so we can assist you.This information will be kept confidential with your campus administrator and/or superintendent.
IF THIS IS AN EMERGENCY AND YOU SUSPECT THERE IS A RISK TO SOMEONE'S LIFE, PLEASE CALL 911.
Person reporting incident - please use your full name.
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First Name
Last Name
I am a:
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Dover Elementary Student
Dover Middle School Student
Dover High School Student
District Staff
Parent/Guardian of Dover Student
Community Member
Date of incident:
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Month
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Day
Year
Date
Who was the person engaged in bullying?
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What is the grade of the person engaged in bullying?
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What type of bullying?
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Physical
Emotional/Social
Damage to Property
Online
Other
Where did this incident take place? Be as specific as possible.
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Describe what happened with as many details as possible.
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May we contact you for more information?
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Yes
No
How would you prefer to be contacted?
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Email
Phone
Meeting
Any of the above
If you prefer email contact, please enter your email address.
example@example.com
If you prefer phone contact, please enter your phone number.
Please enter a valid phone number.
Format: (000) 000-0000.
Submit
Should be Empty: