Directions: Reports of Bullying or Harassment that effect the learning environment or
threaten student safety are serious allegations. Upon submission of this form, the
Principal at the student’s school will be notified. Every reported act of bullying or
harassment will be investigated and parents will be informed.
Anyone can make a report. All school employees are required to report alleged violations. This form can be
completed anonymously by omitting the "Name of Person Reporting the Incident" field.
Contact the school for additional information or assistance at any time.