Instructions:

Please select the school where the report of bullying is happening from the dropdown list below. In the space provided please also let us know any pertinent facts related to the situation, to assist us with the investigative process. If known, the information should include:

1. Who is being harmed?

2. What are the names of any students participating in the bullying?

3. What are the names of any students or adults, who may have witnessed the bullying?

4. What is the location where the bullying is occurring (cafeteria, hallway, classroom, bus, etc…)?

5. When did the incident(s) occur or how frequently is it occurring?

6. Describe the bullying behavior that is taking place: