Trenton School Bullying Report Form

BULLYING REPORT FORM
Please complete this form, responding only to the questions that you feel comfortable answering and are able to accurately answer. You may choose to include your name at the bottom of the form or may submit it anonymously. Please note that the District's ability to investigate an anonymous complaint may be limited, and the District prohibits retaliation against anyone who files a bullying report.

Please note that the IP address from your device will be recorded when you submit this form to minimize prank report submissions. These addresses will only be used to identify prank submissions ONLY. In all other ways, the data submitted here is entirely voluntary on your part and your identity will be confidential.
Date of Incident

MonthDayYear
When did the incident happen?

Before SchoolDuring SchoolAfter SchoolUnsure
If you know more specifically about what time the incident occurred, please enter it below.

:HourMinutesAM/PM Option
Where did the incident happen?

School buildingOn the school playgroundIn the school parking lotOn the school busAt a school eventOnline
Describe what happened or what is happening.
Who was committing the bullying? (if you are unsure of the name, please describe him/her to the best of your ability.
Who was the victim of the bullying? (if you are unsure of the name, please describe him/her to the best of your ability.
Did anyone else witness the bullying? (if yes, please explain)

YesNoUnsure
If yes, please list the name(s) of any witnesses.
Were you or others physically hurt? (If yes, please explain)

YesNoUnsure
Please explain
Was there damage to anyone's personal property? (if yes, please explain)

YesNoUnsure
Please explain whose property and what specifically was damaged
Have you or the victim missed any school or made any changes to your daily routine as a result of the incident(s)? (If yes, please explain)

YesNoUnsure
Have you told anyone else about the bullying? If yes, please tell us whom you've told.
Name (Optional) -- Please understand that a complaint filed anonymously may limit the district's ability to investigate and respond to the alleged violations.
Your grade and age (optional)
How can we contact you? Please list phone number(s) or email addresses at which you can be reached.
Notice

We take all reports of bullying very seriously. However, to minimize prank report submissions, all IP addresses of respondents are recorded. These addresses will only be used to identify prank submissions. In all other ways, the data submitted here is entirely voluntary on your part and your identity will be confidential.
Should be Empty: