Triad CUSD#2 Bullying, Intimidation & Harassment Online Report

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I am a

First and last name of individual filling out this form

Phone number of individual filling out this form

Email of individual filling out this form

What school is this report going to? *

Full name of the student being bullied *

Grade of the student being bullied *

Full name of the student doing the bullying *

Grade of the student doing the bullying *

Where is the bullying occurring? *

Bus

Hallway

Classroom

Bathroom

Lunchroom or Cafeteria

Playground

Social Media and/or Text

At A School Sponsored Activity Or Event Off School Property

Other

Required

When is the bullying occurring? *

Before School

During School

After School

Required

How often is the bullying, intimidation, harassment happening? *

Please describe the bullying situation in detail. *

Please include the following:

List multiple dates/times the bullying situations occurred if known
Is there physical evidence of bullying (notes, text, email, drawing, video, website, etc.)

Has this incident been reported to anyone yet? *

Who was the incident reported to?

Were there any witnesses? *

Names of witnesses

What level of support are you looking for at this time? *

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This form was created inside of Triad Community Unit School District #2. Report Abuse