Harassment, violence, discrimination or bullying report form
Preliminary information
1.
Date of report:
mm/dd/yyyy
2.
Name of person making report:
3.
Phone number(s):
4.
Email address:
5.
I am a (check one):
Select at least 1 and no more than 1.
Student (list grade level/school below)
Parent/guardian
Employee (list position/school below)
Other (list below)