Report Bullying Now

Have you reported this incident to anyone in authority?required

Yes

No

If you answered "yes", who did you tell?required

Name of person you believe is being bullied or harassed.required

First and last name if known)

Where, exactly, did the bullying take place? Be specific as possible regarding the incident(s).required

What happened?Check all that apply

Physical: hitting, kicking, or other physical aggression

Verbal: teasing, name-calling, put-downs, or other behavior that would hurt others' feelings or make them feel bad

Exclusion: starting rumors, telling others not to be friends with someone, or other actions that would cause someone to be without friends

Cyber bullying: using a computer, mobile phone or other electronic device to engage in any previously mentioned bullying

Other, please specify below

Check all that apply

Details for "Other"

Name of the alleged bully.

Please describe the incident.required

Date of the incident

Must contain a date in MM/DD/YYYY format

Did you witness the event?required

Yes

No

Please list others who may have witnessed the incident.

Your name

Optional

Email Address

Optional

Additional comments

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