Anonymous bullying_reporting

Calhoun County School District Anonymous Online Bullying or Harassment Reporting Form

Any student, parent, or employee can report bullying or harassment by talking to an administrator or completing this form and submitting it online.
Victim's Name (First and Last)*
What School does the victim currently attend?
What is the victim's current grade?
Alleged Bully's Name(s) (First and Last)*
What School does the alleged bully currently attend?
What is the alleged bully's current grade?
Witness Name First and Last
What School does witness 1 currently attend?
What is witness 1's current grade?
Witness Name First and Last
What School does witness 2 currently attend?
What is witness 2's current grade?
Date of Incidents*

MonthDayYear
Date
Time of Incidents
Frequency of Incidents
Is this the first time you have been bullied or harassed?

YesNo
If NO, is the bullying by the same person(s) or a different person?

Same PersonDifferent Person
Were any of these incidents previously reported?

NoYes
If Yes, to whom?
Where did the incident happen? (choose all that apply)

at schoolon a school busat a school-sponsored activity or event off school propertyat the bus stopon the way to or from schoolon the computer, email, text, or phoneOther
Choose the statement(s) that best describes what happened (choose all that apply) Theft ThreatStalking Teasing Physical Violence Destruction of Property Spreading False Rumors Other

TeasingPhysical ViolenceDestruction of PropertyThreatSocial ExclusionStalkingPublic HumiliationSpreading False RumorsTheftSexual, religious, or racial harassmentIntimidationCyberstalking or Cyber BullyingOther
Describe what happened
If witnesses are involved, describe their role in this incident.
Signature of student/employee completing this form (optional)

Clear
Date

MonthDayYear
Date
Thank you. This report will be followed up in a prompt manner. By completing this form, you are verifying that your statements are true and exact to the best of your knowledge. If you fear a student is in IMMEDIATE danger, please contact a trusted adult right away!
Should be Empty:

Calhoun County School District Anonymous Online Bullying or Harassment Reporting Form

Any student, parent, or employee can report bullying or harassment by talking to an administrator or completing this form and submitting it online.